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Medicaid Waiver | Home & Community Based Services | SMMC-LTC

Florida Statewide Medicaid Managed Care Long Term Care (SMMC-LTC) / Medicaid Waiver / Home & Community Based Medicaid are all different names for the same program.

This long-term care Medicaid Waiver program is for those who only require Assisted Living Facility (ALF) level of care OR are able to reside at home and would benefit from some home-health care. There is a wait-list for this program.

The Medicaid Waiver wait-list gives priority to those who need services the most. But the wait-list can be quite long. Part of our service, if hired to do so, is coaching you on ethical ways to obtain a higher priority score to minimize time on the waitlist. The Medicaid waiver application is not submitted until the client is called off the waitlist. There is no law that says you need to hire an elder law attorney to assist with the Florida Medicaid Waiver Waitlist process, but having assisted many clients, we believe our efforts directed toward minimizing our client's time on the waitlist provide significant value.

Once off the waitlist, a Medicaid application is submitted (and the client is otherwise eligible), Florida Medicaid waiver services can begin on the first day of the following month. Once approved for waiver benefits, the Medicaid recipient keeps 100% of their income (although a portion may need to be diverted into a qualified income trust, which can still be used to pay expenses).

If in an ALF: Medicaid contributes approximately $1,400.00 (could be slightly more or less, depending on amount of care needed) toward their ALF bill. Importantly, the Medicaid waiver program does not cover the cost of room and board in an assisted living facility.

If at home: Medicaid will typically pay for between 15 - 40 hours of home health care (directly to a Medicaid-approved agency, or to an individual you choose if participating in the participant directed option) depending on amount of care that is needed.

All Medicaid Waiver / SMMC-LTC providers must provide, at a minimum, the following services in accordance with the Statewide Medicaid Managed Care Long Term Care Program Coverage Policy as promulgated by Florida's Agency for Health Care Administration (AHCA):

Every managed care plan must offer at least the following services:

  • Adult Companion
  • Adult Day Care (Adult Day Health Care)
  • Ambulatory Surgical Center Services
  • Assistive Care
  • Assisted Living Facility (ALF) Services
  • Attendant Nursing Care
  • Behavior Management
  • Caregiver Training
  • Case Management
  • Chiropractic
  • DENTAL SERVICES (Dental Exams, Dental X-Rays, Dentures, Extractions (removal of teeth), Pain Management, Problem Focused Exam, Sedation (dental services while asleep or partly asleep), Fillings (silver and white), Flouride, Oral Health Instructions, Sealants, Teeth Cleanings (basic and deep).
  • Emergency Care
  • Eye Care
  • Hearing Services
  • Home Accessibility Adaptation
  • Home Delivered Meals
  • Homemaker
  • Hospice
  • Hospitalizations
  • Immunizations
  • Intermittent and Skilled Nursing
  • Lab Work
  • Medical Equipment & Supplies (including prosthesis and orthoses)
  • Medication Administration
  • Medication Management
  • Nursing Facility Care
  • Nutritional Assessment and Risk Reduction
  • Occupational Therapy
  • Personal Care
  • Personal Emergency Response System (PERS)
  • Physical Therapy
  • Podiatric (Foot) Care
  • Prescriptions
  • Renal Dialysis
  • Respiratory Therapy
  • Respite Care
  • Speech Therapy
  • Transportation to LTC Services

Statewide Medicaid Managed Care - LTC Medicaid Plans Available In Florida

(updated as of 2020 - not all plans are available statewide).

Its important to compare SMMC-LTC Medicaid Waiver plans in Florida because there are some optional benefits, depending on the plan. Some plans offer: help paying for a cell phone, CVS discount program, home delivered meals, housing assistance (rent, utilities, grocery assistance), meal stipend (for long distance medical appointments), over the counter drug assistance, transportation services to non-medical appointments and activities, acupuncture, art therapy, behavioral health services, durable medical equipment, equine therapy, group therapy, carpet cleanings, social worker home visits, massage therapy, family therapy and more.

Below are the Medicaid Long Term Care Programs in the areas that Elder Needs Law, PLLC most commonly serves.

Miami-Dade County and Monroe County Medicaid Waiver LTC Plans (Region 11)

  1. Humana Medical Plan: 800-477-6931
  2. Simply Healthcare Plan: 844-406-2396
  3. United Healthcare: 888-716-8787
  4. Molina Healthcare: 866-472-4585
  5. AETNA Better Health: 844-645-7371
  6. Florida Community Care: 833-322-7526
  7. Staywell: 866-334-7927
  8. Sunshine Health: 866-796-0530

Broward County Medicaid Waiver LTC Plans (Region 10)

  1. Simply Healthcare Plan
  2. Florida Community Care
  3. Humana Medical Plan
  4. Sunshine Health

Palm Beach County and Martin, Indian River, Okeechobee, St. Lucie County Medicaid Waiver LTC Plans (Region 9)

  1. Sunshine Health
  2. Staywell
  3. Florida Community Care
  4. Humana Medical Plan

Lee County and Charlotte, Collier, Desoto, Glades, Hendry, and Sarasota County Medicaid Waiver LTC Plans (Region 8)

  1. Molina Healthcare
  2. Staywell
  3. Sunshine Health
  4. Humana Medical Plan
  5. Florida Community Care

Hillsborough County and Hardee, Highlands, Manatee, and Polk County Medicaid Waiver LTC Plans (Region 6)

  1. AETNA
  2. Humana
  3. Staywell
  4. Simply Healthcare
  5. Sunshine Health
  6. Florida Community Care
  7. United Health

To find and compare different Florida long-term care health plans in different areas of the state, click the link.

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How to Get Medicaid to Pay for Some or All of Your Long-Term Care Expenses:Without having to wait 5 years | without having to sell your house | without have to go broke first! (a Florida Medicaid Lawyer's Guide For Non-Lawyers)


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