In 2011, Florida introduced the Statewide Medicaid Managed Care (SMMC) program, a significant change in how long-term care is delivered through Florida Medicaid. This initiative by the Florida Legislature, involving the Agency for Health Care Administration (AHCA) and the Department of Elder Affairs, reshaped the provision of long-term care services for eligible individuals. The SMMC program is structured into two main components: the Long-Term Care (LTC) Managed Care Program and the Managed Medical Assistance (MMA) Program. For Medicaid recipients who qualify for and enroll in SMMC LTC, long-term care services are accessed through a managed care plan specialized in long-term care.
Florida Medicaid Long Term Care Program Eligibility and Services
Comprehensive Services Under SMMC LTC
Each managed care plan within the SMMC LTC network is contracted with AHCA to ensure a minimum set of essential services are available to participants. These services are designed to support individuals in various long-term care needs and are provided based on medical necessity or to prevent or delay the need for nursing facility placement. The comprehensive list of services includes:
- Adult Companion services for social support and supervision.
- Adult Day Care (or Adult Day Health Care) offering daytime support and activities in a community setting.
- Assistive Care Services to aid with daily living activities.
- Assisted Living Facility Services for those needing residential care in a supportive environment.
- Attendant Care providing personal care and assistance.
- Behavior Management services to address and manage challenging behaviors.
- Caregiver Training to equip family members and caregivers with necessary skills.
- Case Management to coordinate and oversee care plans and services.
- Home Accessibility Adaptation to modify homes for better accessibility and safety.
- Home Delivered Meals ensuring nutritional needs are met at home.
- Homemaker services for household tasks and chores.
- Hospice care for end-of-life support and comfort.
- Intermittent and Skilled Nursing care for medical needs requiring professional nursing.
- Medical Equipment & Supplies necessary for health and daily living.
- Medication Administration and Medication Management to ensure safe and effective medication use.
- Nursing Facility Care for individuals requiring 24-hour skilled nursing care.
- Nutritional Assessment and Risk Reduction to promote healthy eating and address dietary concerns.
- Occupational Therapy to improve functional abilities for daily living and work.
- Personal Care assistance with personal hygiene and grooming.
- Personal Emergency Response System for immediate help in emergencies.
- Physical Therapy to improve mobility and physical function.
- Respiratory Therapy for individuals with breathing difficulties.
- Respite Care providing temporary relief for primary caregivers.
- Speech Therapy to address communication and swallowing disorders.
- Transportation to medical appointments and essential services.
Eligibility for Florida Medicaid Long Term Care Program
To be eligible for services under the SMMC LTC program, individuals must meet specific criteria. Eligibility is determined based on age, Medicaid eligibility, and the need for nursing home level of care as assessed by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit at the Department of Elder Affairs. The eligibility criteria are as follows:
- Be age 65 and over and eligible for Florida Medicaid, or
- Be age 18 and over and eligible for Florida Medicaid due to a disability.
- Additionally, individuals must be assessed by the CARES unit and determined to require a nursing home level of care, meeting established clinical criteria.
For detailed information regarding the Statewide Medicaid Managed Care Long-Term Care program, you can visit the official LTC website provided by AHCA: http://ahca.myflorida.com/Medicaid/statewide_mc/smmc_ltc.shtml.
Independent Consumer Support Program (ICSP)
Florida’s Independent Consumer Support Program (ICSP) is a collaborative effort designed to assist individuals enrolled in or seeking information about the SMMC LTC program. It is a coordinated service 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. This program ensures that SMMC LTC consumers have multiple avenues for accessing information, filing complaints or grievances, appealing decisions, or simply asking questions. The ICSP provides a “no wrong door” approach to complaint resolution, ensuring that queries are directed to the most appropriate entity for efficient and effective assistance.
Further Resources for SMMC LTC Information
For more detailed information on the SMMC LTC program, including program overviews and summaries, please refer to the AHCA website at http://ahca.myflorida.com/Medicaid/statewide_mc/smmc_ltc.shtml.
To explore the LTC plans available in your region and for guidance on choosing a plan that best suits your needs, visit the Choice Counseling website at www.flmedicaidmanagedcare.com.
For inquiries about the SMMC LTC waitlist, it is recommended to contact your local Aging and Disability Resource Center. Direct contact information for ADRCs in each region is available online. You can also reach out to the statewide Elder Helpline at 1-800-96-ELDER for immediate support and assistance.
For help with addressing complaints related to your LTC plan, you can visit AHCA’s website at http://ahca.myflorida.com/SMMC and click on the “Report a Complaint” button for guidance and support.
