What is the Florida Nursing Home 60-Day Transition Rule?

If a person has both been on Medicaid and in a skilled nursing facility/nursing home for a minimum of 60 consecutive days, and that same person has the desire and ability to transition back into the community; then the state, through the CARES program, and the skilled nursing facility administration are required to coordinate and implement a plan to achieve the goal of leaving the nursing home and entering an ALF or return to home without discontinuing Medicaid long-term care benefits.

The Medicaid 60 day transition rule is specifically contemplated in Fla. Stat. 409.979(3)(f)(2), which states in part: 

Notwithstanding this subsection, the following individuals are afforded priority enrollment for home and community-based services through the long-term care managed care program and do not have to complete the screening or wait-list process if all other long-term care managed care program eligibility requirements are met:
A nursing facility resident who requests to transition into the community and who has resided in a Florida-licensed skilled nursing facility for at least 60 consecutive days.
  • [subsections 1 and 3 omitted for brevity]

We are often asked: How can my loved one transition from a Nursing Home to Assisted Living Facility or to a family member's house or to their own house with home health cares assistance partially paid for by medicaid? 

Can I Keep Medicaid if able to go From Nursing Facility to ALF or Home?

Medicaid long-term care programs have a stated program goal of promoting elder independence and placing Florida’s elderly individuals in the least restrictive setting possible. Given that nursing homes are the most restrictive setting meant for those who require the highest level of care, Florida Medicaid has developed a plan for those nursing home residents who desire and are able to transition back into a community setting (i.e. ALF, independent living facility, a family member’s home, or the senior citizen’s own home or apartment).

As described above, if the individual looking to transition from the Medicaid ICP program to the florida medicaid waiver (which will pay for a portion of an ALF bill and a for a certain number of home-health care hours if they prefer to receive care at home), has been in the nursing home for at least 60 days, they will almost seamlessly transition without losing any benefits. This is often referred to as the the Florida Medicaid 60 Day Transition Rule.

However, if the medicaid recipient has only been in the skilled nursing facility for 59 days or less, they will need to start the Florida Medicaid application process all over again, including being placed on the waitlist without any consideration given for their time spent in the nursing home. We strive to assist obtaining as high of a Medicaid waitlist priority score as possible.

What is the process involved with switching from Medicaid ICP to Medicaid Waiver?  

Call CARES or your Florida elder law attorney to guide you through the nursing home transition process.

CARES is already the agency tasked with determining the medical necessity of Medicaid-funded long-term care programs such as nursing home and Medicaid Waiver – they perform the “level of care” assessment for both programs. As a result, CARES is the natural agency to help (a) determine if the senior or disabled individual is able to successfully transition into the community with continued Medicaid assistance; and (b) to coordinate how best to achieve that goal.

Once this is done, the Medicaid participant’s case manager (or they will be referred to a transition case manager) will be expected to meet with the prospective nursing home transition candidate to explain available home and community based services; develop a service plan (with individual’s family) to facilitate a successful transition back into the community; assist the individual in locating community support options; work with any other program case managers to enroll the Medicaid recipient into the appropriate waiver program; assist with exploring housing options; and more.

How to Bypass the Medicaid Waiver Waitlist in Florida?

There is no waitlist for those who require skilled-nursing long-term care placement (which receives its guaranteed funding through the Florida Medicaid Institutional Care Program (ICP)).

Other than relying on the exceptions as set forth in Fla. Stat. 409.979(3)(f)(2), all other long term care Medicaid Waiver applicants will go through a screening and be assigned a Medicaid waiver priority score. This priority score will determine the Medicaid applicant's placement on the home and community based services waiver waitlist.

What if I’m on the wait list for Medicaid Waiver (ALF or Home Health Care) and then require skilled nursing home care?

Again, those who need nursing home care are not subject to the waitlist. As a result if they originally anticipated being able to age at home or in an ALF, and find that their health has deteriorated to the point where this is not possible, then they will be able to jump to the front of the line. By working with an experienced Florida medicaid lawyer to protect assets and income, it is often possible to secure Medicaid funding for the same month in which our client has entered the nursing home.

Skilled nursing home / Medicaid ICP benefits are awarded retroactive to the first of the month in which the Medicaid applicant is receiving nursing home services, meets Medicaid's assets and income tests, and has submitted a Medicaid ICP application (usually with the help of an elder care lawyer).

If interested in Medicaid Waiver / Home and Community Based Services Medicaid to pay for home care or ALF care; or to pay for nursing home care; anywhere in Florida, contact us today.