Senior Resources

Statewide Medicaid Managed Care (SMMC) - Long-term Care Program

In March 2014, Florida introduced the Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC) system.  Under this program all Medicaid eligible seniors who require long term care supports, now receive assistance.  Florida is divided into 11 regions and 7 different Managed Health Care Organizations provide services but not every provider is available in all 11 regions.

How it Works for Families

Seniors who require health care and are financially eligible, select a “Plan” for one of the providers who offer care in their geographic area.  That provider becomes responsible for ALL of the participant’s long term care needs.  Participants still receive their medical services coverage through Medicare or another private insurance policy. Counselors are available to help participants choose a long term care plan.

Having selected a Plan, each participant is assigned a Long Term Care Case Manager who conducts a comprehensive assessment of their care needs.  Family members and other persons knowledgeable about the participant can (and should) participate in the assessment process.  The outcome of the assessment is a Care Plan that states the least restrictive environment in which the participant can receive care (for example home health care, in adult day care, assisted living or a nursing home) and what care and supports they require in that environment.  A complete list of potential services is available in the benefits section below.

The Plan has a network of care and service providers to fulfill all of the needs of the participants.  Nevertheless, each Plan offers clients a degree of ‘participant direction.’  This means program participants have some discretion in who provides them with care services, at a minimum in the areas of personal care and homemaker services.

If a program participant believes they require a level or type of health care, or support service for which they have not been approved in their Care Plan, they can request a Medicaid fair hearing in which a third party organization handles their dispute with the Managed Care Organization.

Eligibility Guidelines

To receive services under SMMC LTC, candidates must meet all of the following criteria:

• Be legal Florida residents
• Be 65 years of age or officially designated as disabled
• Need “nursing facility level of care”
• Meet the financial requirements for Florida Medicaid

Financial eligibility is complicated. The state considers both the applicant’s income and assets.  In 2015, the individual limit for an applicant is $2,199 / month.  For couples, when both parties are applying, the joint income limit is $4,398 / month.  However, when only one spouse applies and the other does not, the couple has more options to qualify with regards to their income. The spouse who is not applying is permitted to keep sufficient income to enable her or him to continue living independently.  In this situation, couples can allocate their joint income to the healthy spouse and help the spouse that requires assistance to qualify for Medicaid.

Consideration of financial assets or resources works in a similar manner. Individuals are allowed up to $2,000 in “countable resources,” and couples are permitted up to $3,000. However, if one spouse is not seeking Medicaid, then that spouse is permitted up to $119,220 in resources or savings. If they continue to live in their home, then the home is considered an exempt asset and its value is not put towards the resource limit.

Persons whose assets or incomes exceed the Medicaid limits or couples where only one spouse requires Medicaid should strongly consider finding Medicaid planning help to ensure they qualify and that the healthy spouse has adequate income and resources to continue living independently.

 Benefits and Services

The following list is comprehensive of what is offered under Florida Statewide Medicaid Managed Care, Long Term Care Program.   Not every participant is eligibility for all of the following services.

• Adult companion care
• Adult day health care
• Assisted living
• Assistive care services
• Attendant care
• Behavioral management
• Care coordination/ Case management
• Caregiver training
• Home accessibility adaptation
• Home-delivered meals
• Homemaker
• Hospice
• Intermittent and skilled nursing
• Medical equipment and supplies
• Medication administration
• Medication management
• Nursing facility
• Nutritional assessment/ risk reduction
• Personal care
• Personal emergency response system
• Respite care
• Therapies, occupational, physical, respiratory and speech
• Transportation, Non-emergency

The state will send Medicaid recipients a letter notifying them as to whether or not they are required to enroll in Florida’s Statewide Medicaid Managed Care – Long-term Care program.

Note: The Statewide Medicaid Managed Care program will not change Medicare benefits.

On this website you will find information about your long-term care options and the choices available to you, which include:

• How to choose a plan
• Information about Plans in your Region
• Information about How to Enroll
• Answers to many of your questions on our Glossary and Frequently Asked Questions page