The Florida Statewide Medicaid Managed Care (SMMC) program was established in 2011 by the Florida Legislature to reshape how specific individuals receive long-term care through Florida Medicaid. This initiative led the Agency for Health Care Administration (AHCA) and the Department of Elder Affairs to modify the delivery of long-term care services. The SMMC program is comprised of two key components designed to cater to different healthcare needs: the Long-Term Care (LTC) Managed Care Program and the Managed Medical Assistance (MMA) Program. For Medicaid recipients who are eligible and enroll in SMMC LTC, long-term care services are administered through a designated long-term care managed care plan.
Florida Medicaid Long Term Care Program logo. Information about Florida Statewide Medicaid Managed Care Long Term Care program.
Services Provided Under the SMMC LTC Program
Each managed care plan contracted with AHCA is mandated to offer a comprehensive suite of long-term care services. These services are designed to support individuals in various aspects of their daily living and healthcare needs. The minimum services include:
- Adult Companion: Providing companionship and support for adults.
- Adult Day Care (Adult Day Health Care): Supervised care in a community setting during daytime hours.
- Assistive Care Services: Assistance with daily tasks to promote independence.
- Assisted Living Facility Services: Care and housing in a residential setting for those needing assistance.
- Attendant Care: Personal care services provided in the individual’s home.
- Behavior Management: Strategies and interventions to address challenging behaviors.
- Caregiver Training: Education and support for family members or individuals providing care.
- Case Management: Coordination of services and support to meet individual needs.
- Home Accessibility Adaptation: Modifications to the home to improve accessibility and safety.
- Home Delivered Meals: Provision of nutritious meals delivered to the home.
- Homemaker: Assistance with household tasks and chores.
- Hospice: Compassionate care for individuals with life-limiting illnesses.
- Intermittent and Skilled Nursing: Part-time nursing care for specific medical needs.
- Medical Equipment & Supplies: Provision of necessary medical equipment and supplies.
- Medication Administration: Assistance with managing and administering medications.
- Medication Management: Oversight and review of medication regimens.
- Nursing Facility Care: 24-hour skilled nursing care in a facility setting.
- Nutritional Assessment and Risk Reduction: Evaluation and interventions for nutritional needs.
- Occupational Therapy: Therapy to improve daily living and work skills.
- Personal Care: Assistance with personal hygiene and grooming.
- Personal Emergency Response System: Electronic device for emergency assistance at home.
- Physical Therapy: Therapy to improve mobility and physical function.
- Respiratory Therapy: Treatment for respiratory conditions.
- Respite Care: Temporary relief for primary caregivers.
- Speech Therapy: Therapy to improve communication and swallowing skills.
- Transportation: Assistance with transportation to medical appointments and services.
The availability of these services is contingent upon medical necessity or their role in preventing or delaying nursing facility placement, ensuring that individuals receive the appropriate level of care in the most suitable setting.
Eligibility for Florida SMMC Long-Term Care Program
To be eligible for services under the Florida Statewide Medicaid Managed Care Long-Term Care program, individuals must meet specific criteria. Eligibility is based on:
- Age and Medicaid Eligibility: Individuals aged 65 and over who are eligible for Medicaid, or individuals aged 18 and over who are eligible for Medicaid due to a disability.
- Nursing Home Level of Care Determination: A determination by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit at the Department of Elder Affairs that the individual requires a nursing home level of care and meets established clinical criteria. Further details about CARES can be found at https://elderaffairs.org/programs-services/comprehensive-assessment-and-review-for-long-term-care-services-cares/.
For comprehensive information regarding the Statewide Medicaid Managed Care Long-Term Care program, please visit the official LTC website at: http://ahca.myflorida.com/Medicaid/statewide_mc/smmc_ltc.shtml.
Independent Consumer Support Program (ICSP)
The Independent Consumer Support Program (ICSP) in Florida provides crucial assistance to individuals enrolled in the SMMC LTC program. This program is a collaborative effort involving the Florida Department of Elder Affairs’ Bureau of Long-Term Care & Support (LTCS), the statewide Long-Term Care Ombudsman Program (LTCOP), local Aging and Disability Resource Centers (ADRCs), and AHCA. Through this coordinated approach, SMMC LTC consumers have multiple avenues for accessing information, filing complaints or grievances, and seeking answers to their questions. This “no wrong door” access ensures that consumers can effectively navigate the program and resolve any issues they may encounter.
Accessing Further SMMC LTC Information
For more in-depth details about the SMMC LTC program, including program summaries and overviews, please refer to AHCA’s website: http://ahca.myflorida.com/Medicaid/statewide_mc/smmc_ltc.shtml.
To explore the LTC plans available in each region and guidance on choosing a plan, visit the Choice Counseling website: www.flmedicaidmanagedcare.com.
For inquiries about the SMMC LTC waitlist, please contact your local Aging and Disability Resource Center. Contact information for ADRCs in your region can be found through the provided link on the original page. You can also reach out to the statewide Elder Helpline at 1-800-96-ELDER for immediate support.
For assistance with complaints related to your LTC plan, AHCA’s website offers a “Report a Complaint” button at: http://ahca.myflorida.com/SMMC.
