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Florida Medicaid Program for Assisted Living

Florida Medicaid Program for Assisted Living

by | Jun 29, 2025 | Blog

Florida Medicaid Program for Assisted Living

🏥 What It Covers

Under Florida’s Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program (an HCBS waiver), eligible seniors can receive:

What it does not cover: the cost of room and board at the ALF—that must be paid separately

Many facilities that accept Medicaid will accept about $1,300 to $1,500/month from Medicaid toward the personal care portion, and the resident or family often pays the remainder ahca.myflorida.com+11elderneedslaw.com+11reddit.com+11.

✅ Eligibility Requirements

  1. Nursing‑Home Level of Care
    You must be assessed by CARES (Comprehensive Assessment and Review for Long-term Care) and determined to require a nursing-home level of care—even if staying in an ALF medicaidlongtermcare.org+3nolo.com+3assistedliving.org+3.

  2. Financial Eligibility

  3. Enrollment Availability
    This waiver is not an entitlement—there’s a capped number of spots and often a waitlist reddit.com+8assistedliving.org+8medicaidlongtermcare.org+8.

📌 What to Do Next

  1. Call CARES via Florida’s Elder Helpline or your local Area Agency on Aging to start the nursing‑home level‑of‑care assessment.

  2. Apply for the SMMC LTC waiver and ask to be placed on the waiver waitlist for ALF services.

  3. Find participating ALFs that accept Medicaid. Many have additional private-pay slots before transfer eligibility elderneedslaw.com+5reddit.com+5reddit.com+5reddit.com+4reddit.com+4ahca.myflorida.com+4.

  4. Plan for the cost gap: Medicaid covers care services but not housing—expect to cover the difference via other income or family support.

🧭 Summary at a Glance

AspectCovered by FL Medicaid waiver?
Personal care in ALF✅ Yes, up to ~$1,300–1,500/month
Room and board in ALF❌ No – you pay the remainder
Nursing‑home level of care requirement✅ Must be met via CARES assessment
Income & asset limits✅ Yes (≤ $2,000 assets; ~$2,250–2,900 income)
Enrollment waiting list⚠️ Yes, may have delays

🗣️ Community Insight

From a Florida family’s experience on Reddit:

“We have her on the Medicaid waitlist, … We were overwhelmed to find out how few [ALFs] take Medicaid … The few that do have very long waitlists.” reddit.com+5sunboundhomes.com+5assistedliving.org+5medicaidlongtermcare.orgahca.myflorida.comnolo.comreddit.com+1assistedliving.org+1reddit.com

Another adds:

“Contact the Elder Helpline … It can take up to 18 months for someone to be approved.” reddit.com+1reddit.com+1

🛠️ What You Can Do Now

  • Start the CARES assessment ASAP to confirm level‑of‑care eligibility.

  • Apply and ask to be placed on the waiver waitlist.

  • Identify ALFs in your area that accept Medicaid participants.

  • Budget for the remaining cost—housing is separate.

  • Optionally, consider VA Aid & Attendance or private care to help cover expenses.

Does Medicare cover assisted living?

Medicare does not cover the cost of assisted living if you’re referring to:

  • Rent or room and board in an assisted living facility

  • Help with activities of daily living (ADLs) like bathing, dressing, or eating

  • General custodial care (non-medical personal care)

However, Medicare may cover specific medical services provided to someone living in an assisted living facility, such as:

  • Doctor visits

  • Outpatient care (e.g., physical therapy)

  • Certain home health care services (if medically necessary and ordered by a doctor)

  • Prescription drugs (under Medicare Part D)

Alternative Options

If you’re concerned about paying for assisted living, here are some common resources that might help:

  • Medicaid (depending on your state): May cover some assisted living costs.

  • Long-term care insurance

  • Veterans benefits (like Aid & Attendance)

  • Private pay or family support

My elderly parent refuses care. What can I do?

My elderly parent refuses care. What can I do?

by | Jan 7, 2025 | Blog

My elderly parent refuses care. What can I do?

I’m sorry to hear you’re dealing with this difficult situation. When parents refuse care, especially if their health or well-being is at risk, it can be incredibly frustrating and stressful. There are a few things you can consider doing, depending on their specific situation, their reasoning for refusing care, and the legal options available to you:

1. Understand Their Concerns

  • Why are they refusing care? Sometimes, older adults resist help because they feel a loss of independence, fear of being a burden, or have concerns about the cost or quality of care.
  • Have a conversation: Approach the subject with empathy. Ask them what specific concerns or fears they have about getting care and try to address them in a way that respects their autonomy.

2. Discuss the Importance of Their Health

  • Explain how the care they’re refusing can improve their quality of life, maintain their independence longer, or prevent worsening conditions.
  • Use specific examples of how delaying care can lead to complications (e.g., if they have a medical condition like diabetes, heart disease, or mobility issues).

3. Offer Alternatives

  • If they’re against full-time care or a nursing home, offer other solutions, such as hiring a visiting nurse, a home aide, or setting up a family care schedule. This can make the care less intrusive.
  • You might also want to suggest telehealth appointments if they’re hesitant to go to in-person appointments.

4. Get Help from a Professional

  • Therapists or counselors: A neutral third party, such as a therapist or social worker, might be able to help mediate the conversation and address any fears or emotional resistance.
  • Doctor’s advice: Sometimes, having their doctor explain why care is important can be more persuasive than anything you say. This might involve setting up a meeting where the doctor can directly discuss the necessity of care.

5. Check for Cognitive Impairment

  • If their refusal of care seems irrational or if they are not understanding the risks, it could be a sign of cognitive decline (e.g., dementia, Alzheimer’s). If you suspect this, a doctor or specialist should assess their cognitive function.
  • Legal options: If their cognitive state is compromised and they cannot make decisions in their own best interest, you might need to consider legal options like guardianship or power of attorney. However, this can be a delicate process and may require legal advice.

6. Know Your Legal Rights

  • Power of Attorney (POA): If your parents have given you power of attorney for healthcare or finances, you may be able to make decisions on their behalf, including arranging care.
  • Guardianship: In extreme cases, if your parents are unable to care for themselves and are refusing help, you may need to pursue legal guardianship. This is a process that involves the court and can give you the authority to make decisions for them.

7. Consider the Long-Term Impact

  • If they continue refusing care and their health worsens, it might become a situation of crisis care, meaning emergency intervention could be needed. However, you should try to avoid this if possible since it can cause additional stress and trauma for both of you.

8. Take Care of Yourself

  • Caregiver burnout is a real concern. If you’re feeling overwhelmed, it’s important to seek support from other family members, friends, or professional caregivers. Caregiving can be emotionally and physically exhausting, so make sure you’re taking care of your own well-being too.

If this is something you’re dealing with, you’re not alone. Many people face similar struggles with aging parents or loved ones. Taking small steps, seeking professional advice, and prioritizing communication can often make a big difference. Let me know if you’d like specific advice or resources on any of the points.

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