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.
Benefits of a Skilled Nursing Facility
Skilled nursing facilities must meet strict criteria and are subject to periodic inspections to ensure that quality standards are being met in order to be certified by the Centers for Medicare & Medicaid Services (CMS). The services a patient receives at a skilled nursing facility are crucial to his or her recovery offering 24/7 healthcare services, physical activity, and social interaction.
Skilled nursing facilities are commonly utilized for short-term rehabilitation stays, which are at least partially covered by Medicare for up to 100 days of “skilled care”. With a 3-night qualifying in-patient hospital stay, Medicare will pay for “skilled care” in a skilled nursing facility at 100% coverage for the first 20 days and then on the 21st day there is a co-pay until the 100th day of that qualifying stay, as long as the client’s care can be justified as receiving “skilled care”. After 100 days, Medicare does not pay anything for Long-Term Care.
Many times, patients go into a skilled nursing facility after being released from the hospital so that they can recover or heal from an injury, illness, or surgery. They remain in the skilled nursing facility until they are well-enough to go home. If they are unable to return home or to transition into an assisted living facility then they could stay long term in the nursing home for custodial care, if necessary. However, Medicare does not pay for long-term or custodial care in a nursing home. Medicaid covers all or a portion of the cost of care for long term or custodial care in skilled nursing facilities. Seniors who have limited assets and low income and who have a medical need for this high level of care would be eligible to apply for the Long-Term Community Care Medicaid benefit to cover the cost of the medical care.
CARES Assessment
The Comprehensive Assessment and Review for Long-Term Care Services (CARES) Department is Florida’s screening program for long-term care applicants. The CARES assessments are done by the Department of Elder Affairs. The Care’s Assessor will review your medical information and perform an assessment with a personal interview asking pertinent questions about your ability to function and the type of help that you require. They will also review your medical conditions in order to decide if a certain level of care is required. This Care’s assessment must show that you meet the nursing home level of care necessary to qualify for Florida’s Managed Long-Term Care Medicaid programs.
Medically Necessary
Once it has been determined that you Do meet a nursing home level of care and meet the financial eligibility requirements, then you would be eligible for the LTCC Medicaid program. At that time, you must review the Long-Term Care Managed Care Medicaid plans (LTCMC) and choose which HMO plan best suits your needs. See Statewide Medicaid Managed Care Plan tab for further information.
