Statewide Medicaid Managed Care Long-Term Care Program

What is Florida’s statewide Medicaid managed care long-term care program? Florida has a program through which Medicaid recipients can access long-term care services. It’s called the Statewide Medicaid Managed Care Long-Term Care Program.

This program has two types of health plans:

  • Health Maintenance Organizations (HMOs); and
  • Provider Service Networks (PSNs).

Florida’s Medicaid Long-Term Care Managed Care (LTCMC) plans cover the costs of the assisted living facility and nursing facility care, along with homemaking services, nursing care, and medical equipment for eligible individuals. There are two steps to qualifying for a LTCMC plan:

  • needing a nursing home level of care; and
  • financial eligibility.


Nursing Home Level of Care

To qualify for Florida’s LTCMC program, you must require a nursing home level of care. This means that you must be able to prove that your condition is serious to the extent that you either:

  • need to be in a nursing home with available round-the-clock nursing care; or
  • need to be in a nursing home if you weren’t receiving supportive long-term care services.

Florida has a screening program for long-term care applicants. It’s called Comprehensive Assessment and Review for Long-Term Care Services (CARES).

CARES assessments are conducted by the Florida Department of Elder Affairs. In these assessments, applicants are personally interviewed. During that interview, you’ll be asked a variety of questions about your ability to function, the help you need, and your medical conditions. A CARES assessment is required to show that you meet the nursing home level of care necessary to qualify for Florida’s managed long-term care programs.


Medical Necessity

Once you’ve shown that you require a nursing home level of care, and you enroll in a managed care plan, the next step is to establish that the service or care you want is medically necessary. Florida managed care plans will only pay for services that are medically necessary. In our state, medically necessary means that the service:

  • is required to protect life, to prevent significant illness or disability, or to alleviate severe pain;
  • is consistent with symptoms of the illness or injury that’s under treatment;
  • is consistent with generally accepted professional medical standards;
  • reflects the level of service that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available in Florida; and
  • is provided in a way not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider.

Your CARES assessment and your treatment providers’ feedback will aid in determining if the particular long-term care service that you want is medically necessary for you.


Contact Us

If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.