What Does Florida Long Term Care Medicaid Cover?
Older Floridians, or their families, usually come to me because they need help paying for home health care, assisted living facility care, or skilled nursing home care without having to spend down all of their assets to qualify for Florida long term care Medicaid services. As a quick reminder, my elder law firm focuses on helping clients throughout South Miami, Kendall, North Miami, Aventura, Hallandale, Hollywood, Davie, Plantation, Pembroke Pines, Brandon, Tampa, and the rest of Florida get the government to pay for approximately 15 to 40 hours a week of home health care, or approximately $1,400 to $1,500 toward an ALF bill, or the lion's share of a semi-private room in a nursing home. After I am done protecting their assets and qualifying my clients for Medicaid's long term care benefits, they begin to realize the additional services that come with being qualified for Medicaid that are not provided by Medicare. For example, it is a welcome surprise when clients seeking home health care or ALF care realize they get a little extra cash in their bank account each month because Medicaid will pay for their Medicare Part B premiums that are usually automatically deducted from their Social Security retirement income. My clients are further pleasantly surprised when they are enrolled in a Florida long term care Medicaid plan and find out how much more Florida LTC Medicaid covers. The Florida Medicaid program that helps pay for home health care and ALF care is often referred to as the Florida Medicaid Waiver Program.
Benefits and Services Provided by Florida Long Term Care Medicaid
All Florida long term care Medicaid plans cover an array of medically necessary services, in addition to normal Medicaid health insurance services such as doctor visits and most prescriptions, and in addition to the home health agency, ALF, and nursing home bill payments. The full Statewide Medicaid Managed Care Long Term Care Program Coverage Policy is available on the Florida Agency for Health Care Administration website. On page four you will find all the Home and Community Based Care services, also referred to as the Medicaid Waiver program benefits, that can be provided for those who do not yet need nursing home care. Some of the services that Florida Medicaid LTC must cover for those who wish to age at home but who need assistance are listed below.
Adult Companion Care
Adult companion care covers non-medical care when needed to protect the health, safety, and well-being of long term care Medicaid recipients. This includes help with common household chores such as light housekeeping, laundry, and meal preparation. If someone is needed to administer medications, this can also be provided. As a corollary to this service, when a Florida long term care Medicaid enrollee has someone to assist with these duties and that person is temporarily unavailable, homemaker services can be obtained on a short term basis at no extra cost. In addition, short term respite care can be provided when the usual caretaker needs a break or vacation. When a family caregiver has to work, it can make sense to request a care plan that includes regular visits to an adult day care center.
Adult Day Care
Adult day care will be provided with meals included when the Medicaid recipient is at the adult day care center during a meal time. Adult day care centers also provide medical screenings, routine blood pressure and diabetes maintenance checks, and the provision of therapies such as physical therapy, occupational therapy, and speech therapy that are part of the patient's prescribed care plan.
Accessibility Adaptation for the Home
Florida long term care Medicaid will provide needed adaptations to the house. Examples include installing ramps, grab bars, and widening doorways, as well as modification of bathroom facilities and installing specialized electric or plumbing equipment needed to accommodate medical equipment. These adaptations allow the Medicaid enrollee to remain safely in the home.
Caregiver Training
Those who provide uncompensated care can obtain guidance and training on treatment regimens and how to use durable medical equipment, as well as companionship and supervision support.
Dental, Vision, and Hearing Care
Florida long term care Medicaid covers routine dental, vision, and hearing services. This is a benefit that Medicare does not provide in most circumstances, making it one of the more valuable and often overlooked advantages of Medicaid enrollment for seniors.
Home-Delivered Meals
When a Medicaid recipient cannot shop or prepare food without assistance, meals may be delivered to their home as part of their Medicaid care plan.
Medicare Premium, Co-Pay, Co-Insurance, and Prescription Coverage
For those who need assistance paying for medical-related expenses and do not want to wait for the Medicaid Waiver program, we also assist with qualifying clients for the Qualified Medicare Beneficiary program. This program helps cover Medicare Part B premiums, co-pays, co-insurance, and most prescription costs.
Personal Emergency Response System
If warranted, your long term care Medicaid plan should also provide a life-alert style device that can call for help in case of an emergency.
Transportation
The provision of transportation to and from SMMC-LTC services and benefits will be provided if needed.
Full List of Minimum Covered Long Term Care Program Services
In addition to the services described above, the following are covered under all Florida long term care Medicaid plans.
- Home accessibility adaptations
- Homemaker services
- Medical equipment and supplies
- Medication management
- Nutritional assessment
- Personal care, medication administration, and adult companion care
- Attendant nursing care
- Care coordination and case management
- Respite care
- Physical therapy, occupational therapy, respiratory therapy, and speech therapy
- Non-emergency transportation
Those enrolled in a Florida long term care plan will be provided a one-page summary of the services authorized on their plan of care. Some long term care plans offer additional services such as provision of cell phones, emergency financial assistance, hearing evaluations, and non-medical transportation.
What Is Included in the Medicaid Waiver Care Plan
The Medicaid waiver care plan, which you should be provided in writing upon request, should include the care plan's effective date, when it will be reviewed which is at least every 90 days, the Medicaid recipient's personal goals, strengths, and preferences. The Medicaid managed care plan, provided by the plan's case worker assigned to the Florida Medicaid enrollee, will also include which medical services are needed routinely, how often they are needed, which medical providers are delivering the services, who is naturally available to help with the Medicaid enrollee's care such as family who live with the recipient or close by, and medication oversight strategies. If the enrollee is in an ALF, the care plan will include services being provided by the ALF, how much and how often. Finally, the care plan will include a statement indicating that the Medicaid recipient has the right to file a grievance, appeal, and fair hearing if services that they believe are necessary have been denied, reduced, terminated, or suspended by the Medicaid managed care plan.
What Medicaid Waiver Does Not Cover
Understanding what long term care Medicaid does not cover is just as important as knowing what it does cover. Florida Medicaid does not pay for room and board at an assisted living facility. It covers the medical and personal care services provided there, but the monthly accommodation cost is a separate expense the resident or their family must continue to pay privately. This distinction catches many families off guard when they first enroll. Florida Medicaid also does not guarantee unlimited home health care hours. Once approved, the Medicaid managed care plan will authorize a specific number of hours per week based on the recipient's assessed level of need. If you or your loved one requires more hours than Medicaid authorizes, you have the right to appeal that decision. A Florida Medicaid planning attorney can assist you in building the case for additional hours and navigating that appeals process. It is also worth noting that not all assisted living facilities accept Medicaid. Every nursing home in Florida that accepts Medicare is required to accept Medicaid, but ALFs operate under different rules and may choose whether to participate. Working with an elder law attorney can help you identify facilities in your area that accept Medicaid and meet your loved one's care needs.
How the Florida Medicaid Waiver Waitlist Works
One of the most common points of confusion for families is that qualifying for Florida long term care Medicaid does not mean services begin immediately. The home and community-based services component of the program, which covers home health care and ALF care, operates on a waitlist. The waitlist gives priority to those with the greatest level of need, but the wait can be substantial. There are ethical and legal strategies available to improve a client's priority score on the waitlist and reduce the time spent waiting. This is one of the practical services our office provides as part of a comprehensive Medicaid planning engagement. If nursing home level care is needed immediately, the Institutional Care Program does not have a waitlist and coverage can begin as soon as eligibility is established.
How to Obtain Florida Long Term Care Medicaid Benefits
To qualify for Florida long term care Medicaid in 2026, a single applicant must have no more than $2,000 in countable assets and monthly income below $2,982. If your or your loved one's assets or income currently exceed these limits, it is imperative that you contact an experienced elder law attorney who focuses on Medicaid planning. We can show you how to legally and ethically protect your income and assets without having to wait five years, without having to sell your house, and without having to go broke first. More information about the differences between Florida's long term care Medicaid programs and the Florida Statewide Medicaid Managed Care program can be found at the links. Additional information on what Florida long term care Medicaid covers can also be found at the Florida Department of Elder Affairs. Call to schedule a consultation today at (305) 931-0478 or contact us online.
Frequently Asked Questions About Florida Long Term Care Medicaid Coverage
Q. Does Florida Medicaid cover nursing home care?
A. Yes. The Institutional Care Program, also called ICP, is the Florida Medicaid program that covers the majority of the cost of a semi-private room in a skilled nursing facility. All nursing homes in Florida that accept Medicare are required to accept Medicaid, so this program can assist with care at virtually any nursing home in the state.
Q. Does Florida Medicaid cover home health care?
A. Yes. Through the Medicaid Waiver program, also known as the Statewide Medicaid Managed Care Long Term Care program, Florida Medicaid can pay for approximately 15 to 40 hours per week of home health care for eligible recipients. The number of hours authorized depends on the recipient's assessed level of need and is determined by the managed care plan.
Q. Does Florida Medicaid cover assisted living facilities?
A. Yes, but with an important limitation. Florida Medicaid covers the medical and personal care services provided at an assisted living facility through the Medicaid Waiver program. It does not cover room and board, which is the monthly accommodation cost. Residents must continue paying that portion privately. Not all ALFs participate in Medicaid, so it is important to confirm participation before selecting a facility.
Q. What is the difference between Florida Medicaid and Medicare for long term care?
A. Medicare is a federal health insurance program that covers short term skilled nursing care after a qualifying hospital stay, typically up to 100 days under specific conditions. It does not cover ongoing long term custodial care. Florida Medicaid is a needs-based program that can cover ongoing nursing home care, home health care, and assisted living services for those who meet the income and asset eligibility requirements.
Q. How long does it take to get approved for Florida long term care Medicaid?
A. For the Institutional Care Program covering nursing home care, there is no waitlist and approval can occur relatively quickly once the application is submitted with complete documentation. For the Medicaid Waiver program covering home health care and ALF care, there is a waitlist. The length of the wait varies based on the applicant's priority score. Working with an elder law attorney can help improve your position on the waitlist and ensure the application is filed correctly the first time to avoid delays.
Q. Can Florida Medicaid cover dental, vision, and hearing care?
A. Yes. Florida long term care Medicaid covers routine dental, vision, and hearing services for enrolled recipients. This is one of the notable advantages over Medicare, which does not cover most routine dental or vision care.
