Who it serves
Under s. 409.979(1), you're eligible for the LTC program if you have Medicaid and:
- are 65 or older, or 18 or older and eligible for Medicaid because of a disability, and
- are found by the state's CARES program to need nursing facility care (or hospital-level care for cystic fibrosis).
Three agencies share the work: AHCA runs the program and enrolls you in a plan, the Department of Children and Families (DCF) decides financial eligibility, and CARES decides medical eligibility.
What it covers
LTC plans must cover at least (s. 409.98): nursing facility care, services in assisted living facilities, hospice, adult day care, personal care, home-delivered meals, respite care, intermittent and skilled nursing, therapies, medication management, medical equipment and supplies, home accessibility changes, a personal emergency response system, caregiver training, case management and transportation to LTC services.
Medicare covers only short skilled nursing facility stays after a qualifying hospital stay, up to 100 days per benefit period. It doesn't pay for long-term custodial care, which is why the LTC program matters for Floridians with Medicare.
The wait list for care at home
Space for home and community-based services is limited. A phone screening gives you a priority score, and Florida keeps a statewide pre-enrollment list; people are released by score as funding allows (s. 409.979(3)). After release, CARES staff visit to confirm your level of care and DCF checks your finances. A nursing home resident of at least 60 consecutive days who wants to move back to the community can be enrolled without waiting. Nursing home residents who qualify for Medicaid don't go through the list.
Income and assets
Nursing home and home-based LTC Medicaid have an income cap of 300% of the SSI federal benefit rate. Above it, a Qualified Income Trust (Miller trust) can make you eligible. DCF reviews gifts made in the 60 months before you apply, and Florida can recover Medicaid paid after age 55 from your estate, with exceptions. Details: Florida Medicaid long-term care.
If you also want your Medicare and Medicaid long-term care from one company, a FIDE SNP may be available where you live. You can request a call from a licensed insurance agent to review Medicare plans from the companies they work with.
Related questions
Can I have Medicare and Medicaid in Florida?
Full Medicaid vs. Medicare Savings Programs.
What is MEDS-AD Medicaid in Florida?
Why long-term care changes MEDS-AD eligibility.
What is a FIDE SNP in Florida?
One plan for Medicare and Medicaid long-term care.
Sources
- AHCA — Long-term Care Program
- AHCA — Pick a Long-Term Care Plan
- Fla. Stat. 409.979, Long-term care eligibility
- Fla. Stat. 409.98, Long-term care plan benefits
- Fla. Admin. Code 65A-1.713, SSI-related Medicaid income rules
- Medicare.gov — Skilled nursing facility care
More questions in this guide
- Do I have to join a Medicaid managed care plan if I have Medicare in Florida?
- Can I have Medicare and Medicaid at the same time in Florida?
- Can permanent residents get Florida Medicaid?
- How do I renew my Florida Medicaid on ACCESS Florida?
- What is a dual eligible special needs plan (D-SNP) in Florida?
- What is a FIDE SNP in Florida?
- What is MEDS-AD Medicaid in Florida?
Part of the guide: Florida Medicaid and Medicare together · All questions
Frequently asked questions
Does the LTC program cover doctor visits?
No. The LTC program covers long-term care services only. Your doctor visits and hospital care come from Medicare and, with full Medicaid, your Medicaid medical (MMA) plan.
Can I get LTC if I have Medicare?
Yes. Florida law says Medicaid recipients who meet the age and level-of-care rules receive long-term care through the LTC program; having Medicare doesn't exclude you (s. 409.979(1)).
How do I choose an LTC plan?
After you're found eligible, AHCA mails a welcome packet. Choice counselors at 1-877-711-3662 can help you pick a plan, and you can change plans in the first 120 days.
Medicare in your Florida county
Plans, local agents and help, county by county: Miami-Dade · Broward · Palm Beach · Hillsborough · Orange · Duval · Pinellas · Lee · Polk · Pasco · Brevard · Volusia · Seminole · Sarasota · Osceola · Manatee · Lake · Marion · Collier · St. Lucie · All 67 counties →
