Florida State Assistance

The state of Florida has a comprehensive Medicaid program that covers medical and long term care for eligible Florida residents. The Florida Medicaid program for long-term care provides medical coverage and care for children, pregnant women, the needy, disabled adults and the elderly who would have otherwise not been able to meet the cost of medical services and care provided.  Often Florida citizens are left in poverty due the cost of long term care draining their savings.  When this happens, the state kicks in as the payer of last resort.

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Medicaid programs are different for different states. The federal government decides what services should be provided in specific states and what services are not required. States may offer certain services that the federal government has deemed not compulsory at their on discretion.

Medical Services Covered by Florida Medicaid

Florida Medicaid covers a number of medical services. The type and amount of medical services provided depend on a number of factors including the type of Medicaid program the beneficiary is enrolled to, the type of services determined necessary medically, and the age of the beneficiary among other factors.

Medicaid services will cover costs for a doctor, hospital, dental and visual, home health care, hospice, nursing home, community behavioral health, family planning, child health program services and even transportation costs.

Prescription Drugs

The Florida Medicaid program covers costs of prescription drugs for those who are eligible for this coverage. Prescription drugs coverage for Individuals covered by both Medicaid and Medicare is provided for under Part D of the Medicare Prescription Drugs Benefit.

Medicare Part D Prescription Drug benefit is an insurance benefit that helps individuals with Medicare meet the cost of prescription drugs.

Medicaid Eligibility in Florida

Medicaid in Florida provides medical coverage to low-income families and individuals.  Florida Medicaid services are administered by the Agency for Health Care Administration and eligibility is determined by the Department of Children and Families (DCF) or the Social Security Administration (for Social Supplemental Income recipients).

The Department of Children and Families determines eligibility for parents, caretakers relatives of children, children, former foster care individuals, non-citizens with medical emergencies, pregnant women and aged or disabled individuals who are not currently not receiving Supplemental security Income (SSI).

Presumptive eligibility determinations may be made by hospital providers enrolled by Florida Medicaid in accordance with federal law and state policy. Presumptive eligibility determinations made by qualified hospitals (QH) affect infants and children under 19 years of age, parents and caretakers relatives of children, individuals under 26 years of age and pregnant women receiving Medicaid.

SSI-Related Medicaid

The Social Security Administration determines Medicaid for elderly low-income individuals aged 65 years or older or the disabled. Florida residents eligible for the Supplemental Security Income (SSI) are eligible for Medicaid service coverage from Social Security Administration. These individuals do not have to file separate ACCESS Florida Application if nursing home services are not needed. However, if nursing home services are needed, they will have to file the Access Florida Application online and submit the file electronically. Applicants for regular Medicaid coverage and other services will also have to do the same.

To benefit from Florida Medicaid program for long-term care, individuals applying for Medicaid services will have to check, on the Benefit Information screen, the box for HCBS/ Waivers or Nursing home.

Choosing a Long Term Care Plan

A number of Medicaid beneficiaries in Florida are signed on a form of health plan. Health plans provide coordinated medical care for Medicaid beneficiaries. Individuals choose the health plan suitable for them and which is available in their area. They can see health care providers who are part of the health plan of their choice. These health plans include Health Maintenance Organizations (HMOs), MediPass, and Provider Service Networks (PSNs).

After applying for and getting approval for Medicaid, individuals will have to choose a Medicaid health plan. to do this they can call the Medicaid Options toll-free number (888) 367-6554 or TDD (800) 653-9803. They can also check out their options by visiting the Medicaid Options website and MedicaidOptions.net.

Medicaid beneficiaries living in Broward, Clay, Baker, Nassau or Duval county should call the Medicaid Choice Counselling till-free number (8860 454-3959 or TDD (866) 467-4970. They can also visit their website at FLMedicaidReform.com.

Long-term care managed care plan (LTCMC)

Paying for long-term care has become rather expensive with the average cost of nursing homes in Florida coming to $7,500 per month. Because of this and because the Florida Medicaid program for long term health care accounts for a large part of Medicaid expenditure, the state sought to transition long-term care beneficiaries into a managed care system. This transition is governed by long-term care partnership program.

Currently, almost all beneficiaries of the Florida Medicaid program for long-term care have to enroll in one of seven LTCMC (Long Term Medicaid Managed Care) plans. Private companies operate these plans.

Benefits of LTCMC

All LTCMC plans have to cover certain primary services. These core services include assisted living facility, nursing care facility, adult day care, caregiver training, home accessibility adaptation, case management, homemaker services, nursing care, hospice, home-delivered meals, medical equipment and supplies, administration and management of medication, personal care, respite care, personal emergency response systems, transportation, occupational therapy, speech therapy, respiratory therapy, and physical therapy.

Different plans offer a number of different optional benefits including payments for the cost of holding your bed at the assisted living facility, dental services, vision services, and the cost for moving from home to the nursing home among other optional benefits.

Long-Term Care Managed Care Plan Obligations

The formulation of the long-term care partnership program that saw the introduction of long-term care managed care brought the worry that Medicaid beneficiaries may lose some benefits. This fear by consumer advocates argued that managed care plans may be motivated to cut on costs in order to increase profit margins and hence leave out some benefits.

Florida implemented some comprehensive protection details for beneficiaries of Florida Medicaid program for long-term care. This protects recipients of long-term care during the transition to managed care. The plan is supposed to come up with a care plan for each beneficiary and outline what services they will receive and from where they will receive these services.

Florida Long Term Care Partnership Plan

If you buy long-term care insurance policy that meets certain state provisions, you get additional protection under the long-term care partnership program. The state of Florida seeks to ensure that beneficiaries of Florida Long-Term Care policies are able to apply to the Medicaid program for long term care.  Should they exhaust their policy benefits, this gives to access quality medical care regardless of the service provider. If there is any issue or problems arising from a misunderstanding between the service providers, the beneficiary or otherwise about issues related to the Medicaid program in Florida, write the Department of Children and families or Social Security Administration.

Supplemental Information

Additional information on Florida State Assistance.
Florida participates in the DRA Partnership program that may provide asset protection if you have a qualified Long Term Care policy. Contact an agent about how your plan can qualify.
Florida Partnership Center

State Medicaid Info

AHCA Statewide Managed Care Program

Medicaid Reform: Georgetown U.
Updated July 2014

"I was concerned I may not qualify due to some arthritis treated by medications. Once I spoke with LTC Tree, I felt like I had a plan of companies that would accept me. Two months later, my application was approved and after a short Q&A with my agent I sent in the premium and put coverage in force. All is well.

Don B., Ft Myers Florida

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