Are you worried your loved one will be trapped on Florida’s assisted living Medicaid waitlist? You may have options! Here’s what you need to know to rank higher or legally bypass the ALF waiting list entirely.
As a Pinellas Co. resident, you may have heard that to access Medicaid benefits for moving into an Assisted Living Facility (ALF), you or your loved one will be put on a lengthy waiting list. Florida’s Medicaid waiting list numbers are higher than any other state, reaching into the thousands. It can take years for a person to get the Medicaid funding they need for assisted living or in-home care.
This is understandably upsetting to those who need essential ALF, Home and Community Based Medicaid services and housing options. The good news is there’s a legal way to avoid or bypass the assisted living Medicaid waitlist in many cases.
Welcome, I’m John Frazier, a Pinellas Medicaid planning attorney. I handle ALF Medicaid waitlist cases statewide and work with all of the Area Agency on Aging (AAA) offices throughout Florida.
Today I have important information to share with you about how to navigate Florida’s Medicaid waiting list to attain higher priority placement, and in many cases bypass the waiting list altogether under a Florida Medicaid rule known as the “60 Day Nursing Home Transition Program.”
About Florida’s Assisted Living Medicaid Waitlist
There is currently no waiting list to apply for nursing home Medicaid. However, there is a vast waiting list to apply for assisted living Medicaid. Tragically, there are not enough Medicaid dollars or resources to meet the needs of all who need assisted living Medicaid in Florida.
Each Medicaid applicant on the waiting list is ranked so that the most infirm and needy will be served first. Think of it as a priority list. Applicants with the highest scores are the next to receive Medicaid benefits, at which time their names come off the list and they proceed to the next step.
Florida Medicaid for assisted living care and home health care is a service provided by the Florida Medicaid Waiver Program. Thus you may also see the waiting list referred to as the Florida Medicaid Waiver Wait List. It is all part of the Florida Statewide Medicaid Managed Care program.
How to Get On the Assisted Living Medicaid Waitlist
If you require non-nursing home Medicaid services, it is in your best interest to get on this waiting list as soon as possible. Medicaid waiting lists are overseen by the Department of Elder Affairs and managed by your local Florida Area Agency on Aging (AAA).
Florida Statutes divide our state into eleven “Medicaid Planning and Service Areas” (PSA). Pasco and Pinellas Counties make up PSA 5. AAA offices can go by many names. In some regions of Florida, they are called Elder Options, Elder Source, Senior Connection, Senior Resource Alliance, and Alliance for Aging, Inc., among others. We work with AAA offices statewide and will locate the appropriate AAA office to assist you.
The Pinellas County AAA center is The Area Agency on Aging of Pasco-Pinellas. It is your initial starting point to join the waitlist for the Statewide Medicaid Managed Care program. In Pinellas County alone, nearly 300 licensed Assisted Living Facilities serve over 9,000 people.
The first step is for you or your elder law attorney to call your local AAA. As your legal representative, our law office will contact the appropriate agency and provide them with the initial information required to begin the process. A caseworker from the AAA will then contact you for an interview.
Note: To get a spot on the assisted living Medicaid waitlist, you do not need to be qualified for Medicaid financial assistance. Medicaid eligibility requirements can be handled once you are on the list. During the waiting period, as your attorney, I will manage the details of the Medicaid application process, and help you legally protect your assets so that you meet the eligibility requirements for the Florida Medicaid program.
How Florida Medicaid Waiting Lists Are Scored – Form 701S
To understand the level of care you need, the Agency will conduct an interview with you. During the interview, a caseworker will ask you questions and use your responses to complete Form 701S. This form is a screening tool that enables AAA to determine your score for placement on the Medicaid priority list.
To preview the 701S Screening Form, click the links below. The form is available in English and Spanish. Each PDF form opens in a new window:
The AAA uses a ranking system of 1—8, based on an algorithm. For most clients, a rank of 1—5 will be assigned based on the information obtained from the completed 701S form. A rank of 5 is the highest score, and a rank of 1 is the lowest score.
In terms of determining your rank on the waiting list, a score of 5 is the desired score. For your name to be released from the assisted living Medicaid waitlist, a score of 5 must be assigned. Any score lower than 5 is not considered a priority and can be challenged in an administrative hearing.
Higher scores of 6, 7, and 8 may be assigned but are much less common. A score of 6 means that the applicant has passed a certain age, so they have aged out of the scoring system. A score of 7 is referred to as the Imminent Risk category. An example of Imminent Risk would be if you received an eviction notice from the ALF. A score of 8 is referred to as “Adult Protective Services” (APF) score or a “high risk” client.
What Happens After the AAA Interview?
The completed 701S form contains your priority score. Following the interview with the AAA caseworker, it is very important that you request a copy of your completed form so that:
- Our office can review the form and your score to verify that it was completed fully and accurately by the AAA caseworker;
- If you receive a score of less than 5, as your attorney I will know to take additional steps to increase the score.
Once the AAA interview is over and a priority score is determined, the waiting begins.
Remember! Being released from the assisted living Medicaid waitlist does not mean that you automatically become enrolled in the Medicaid program. You must have also completed the required Medicaid eligibility steps including the application for Medicaid eligibility determination.
While you are on the waiting list, as your Medicaid planning attorney I will take all the steps necessary for you to become Medicaid qualified. You will be ready to submit the application at the appropriate time.
How to Rank Higher on the ALF Medicaid Waiting list
Our objective is to honestly answer the Form 701S questions, with the goal of obtaining a score of 5.
Before your AAA interview, we will provide a blank copy of the 701S form for you to review. We want to make sure you are familiar with the questions you need to answer during the screening process. It is easy to forget or miss details that seem unimportant yet can make a difference in the agency’s understanding. Some questions might seem confusing. We will clarify all questions so you will be prepared to answer in a way most advantageous to your case.
How to Bypass the Assisted Living Medicaid Waitlist
There is a little-known program that will help you gain access to Assisted Living Medicaid benefits AND allow you to bypass the Medicaid Waiver waiting list for ALF completely. It is called the “60 Day Nursing Home Transition Program,” in which a Medicaid applicant goes directly to a nursing home first.
The 60 Day Nursing Home Transition Program
Nursing homes often provide skilled medical support to individuals who need to heal or recover before they can move to an assisted living setting. For example, a person might be placed in a nursing home for a period of rehab after a fall or stroke. As the resident becomes able to function in a less medically intensive, less costly setting, they will want to transition out of the nursing home and into an Assisted Living Facility.
The 60 Day Nursing Home Transition Program streamlines the process for these transitioning residents, by automatically assigning them priority placement into assisted living care and other services. These residents become eligible for the assisted living Medicaid program without ever being on the assisted living Medicaid waitlist.
However, two important conditions must be met. A nursing home resident in transition must:
- currently be eligible for and receiving nursing home Medicaid benefits
- have spent 60 consecutive days in the nursing home
Caution! Before a resident can move from the nursing home to the assisted living facility:
- The nursing home Medicaid application must be approved before the Medicaid applicant can move to the assisted living facility. This is true even if it takes longer than 60 days for the Florida Department of Children and Families (DCF) to approve the Medicaid application.
- The Managed Medicaid Provider involved in the case must approve the move from the nursing home to the assisted living facility first. This is true even if it takes longer than 60 days for DCF to approve the Medicaid application.
If these rules are not followed, you will not be on Medicaid when you move to the assisted living facility. As your attorney, I will make certain all required conditions are met.
How a Florida Medicaid Attorney Can Help
A key part of my Elder Law and Medicaid planning services is to legally guide families with aging and disabled loved ones through Florida’s ALF waiting list crisis. I represent our most vulnerable elders as they continue to wait for much-needed funds.
My services include helping potential Medicaid applicants statewide to:
- get on the Assisted Living Medicaid waitlist with the best possible priority score,
- transition from a nursing home to an assisted living facility while maintaining your Medicaid benefits, and
- bypass the Medicaid waiting list.
Our office will counsel you through all Medicaid planning goals and transactions. We prepare and file applications for Medicaid with the DCF and follow up throughout the application process. I will do everything legally possible to make the system work to your benefit. Together we will work to get you the best outcome possible under the law.
We work with Pinellas nursing homes, assisted living facilities, and the Statewide Medicaid Managed Care program to coordinate your benefits.
I also have a working relationship with the Law Offices of Joseph F. Pippen Jr. & Associates, with multiple offices throughout Florida, which enables me to deliver to you all of the resources of that firm as well.
Call for a free telephone consultation and find out how I may help:
- Week days call us directly at (727) 260-2581
- After 5 PM or weekends please call my cell phone at (813) 431-3193