Now I’m approved for Medicaid, What’s Next?

Statewide Medicaid Managed Care

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Once you receive the LTCC Florida Medicaid eligibility, then you must choose a LTCMC Medicaid plan or the state will choose one for you.  Go to the MyFlorida.com website at https://members.flmedicaidmanagedcare.com/ to learn your Medicaid number and with that number you can enroll into the dedicated portal for FL Medicaid. This portal allows you to pick a plan for medical and dental.

Florida transitioned the long-term Medicaid recipients into a Statewide Medicaid Managed Care (SMMC) system in order to control costs. There are three different programs that makeup Statewide Medicaid Managed Care:

* (MMA) – Managed Medical Assistance Program
* (LTCC) – Long-Term Community Care Program
* Dental Program

These programs consist of eleven regions throughout Florida and have various Long-Term Care Managed Care (LTCMC) Medicaid plans to serve them. The plans are operated by private companies, mostly Health Maintenance Organizations (HMO’s).

All the LTCMC plans must cover certain core services including: adult day care, assisted living facilities, nursing facility care, caregiver training, case management, home accessibility adaptation, home-delivered meals, homemaker/chore services, hospice, nursing care, medical equipment and supplies, medication administration and management, personal care, personal emergency response systems, respite care, transportation, and occupational, physical, speech, and respiratory therapy services.

You can compare and choose Florida LTCMC plans at The Florida Agency for Health Care Administration Site. You can also receive help from Choice Counselors at 1-877-711-3662 to answer questions and help you make a decision about the Managed Care Medicaid Programs from M-TH 8am-8pm, and F 8am-7pm.

What will Medicaid Cover?

Snapshot of the Florida Statewide Medicaid Managed Care Program

Nursing Home Level of Care

To qualify for Florida’s Long-Term Community Care (LTCC) Medicaid program for nursing home care, you must meet the medical criteria for a nursing home level of care. That means that your condition is serious enough that you either need to be in a nursing home, require the need for round-the-clock nursing care, or would need to be in a nursing home if you were not receiving supportive long-term care services in another environment.

Nursing Homes, now more commonly known as Skilled Nursing Facilities (SNFs), function as a licensed healthcare facility for individuals who require a higher level of medical care than can be provided in an assisted living facility or at home. Skilled nursing staff consists of RNs, LPNs, and certified nurse’s assistants (CNAs) who are available to provide 24-hour medical attention and assist with Activities of Daily Living Skills. They have a Medical Director who oversees the care and works alongside a core team of healthcare professionals including Administrator, Nursing, Physical, Occupational, and Speech Therapy, Dieticians, Social Workers, as well as others.

Asset Limits

When needing long-term care and moving into a Skilled Nursing Facility, most people pay privately for the cost of the long-term care services until they can become eligible for Medicaid. Since very few people have long-term care insurance or can afford to pay for the high cost of nursing home care privately very long, eventually most people qualify for Medicaid. Medicaid has become the primary source of funding for nursing home care and has become the long-term care insurance of the middle class.

To Qualify for Florida’s Long-Term Care (LTCC) Medicaid program, you must have limited assets. The state considers assets as money in the bank, retirement accounts, land, and personal property, including cars.

A single applicant’s allowable “countable assets” limit is $2,000 to be eligible for Medicaid in Florida as of 2021. If both of the married couple needs to move into a skilled nursing facility in Florida, then the Medicaid eligibility allowable “countable assets” limit collectively is $3,000 as of 2021.

Home Health Services

Most people receiving long-term care assistance live at home and are not in a nursing home. They are able to reside in their home environment because of the care that they are receiving from their family members and/or from professional medical services, such as Home Health Care.

Home Health Care Services can include skilled nursing, therapy services, or home health aides; including medication management, bathing assistance, or personal care services like meal preparation or cleaning.

LTCMC Medicaid plans offer Home Health Services as part of their benefit package. So if you are a participant in a LTCMC plan, then you are eligible to receive assistance from skilled nurses, home health aides, or personal care attendants in your home, as long as your doctor or LTCMC care coordinator has authorized for those services and has deemed the treatment as medically necessary.