Can You Use Medicaid to Pay for Assisted Living in Florida?
Florida’s Medicaid program doesn’t directly cover the cost of assisted living but offers the Long-Term Care Wavier that can help pay for certain services within a residential care environment. Florida Medicaid typically covers the room and board portion for seniors who require a nursing home level of care.
The Long-Term Care waiver is covered under the Statewide Medicaid Managed Care Program (SMMC). Most state Medicaid recipients receive their services through this program. Aside from the Long-Term Care waiver, two other programs make up the SMMC: the Managed Medical Assistance Program (MMA) and the Dental Program.
Waiver Programs for Assisted Living in Florida
Long-Term Care Waiver
The Long-Term Care Waiver in Florida provides support and services to people aged 18 and older who have specific chronic conditions, as well as seniors aged 65 and up who need nursing home care. It’s an entitlement program, which means there are limited active participants. Once the plan limits have been met, eligible individuals are placed on a wait list. Services covered in an assisted living community include meals, personal grooming and mobility.
To qualify, seniors must be:
- Aged 65 and older
- A resident of Florida
- Currently enrolled in Medicaid Parts A and B
- Nursing home eligible
- Eligible for Medicaid by meeting certain asset and income limits
Seniors must apply at a local Area Agency on Aging.
Eligibility for Medicaid in Florida
To receive benefits, Medicaid recipients in Florida must meet income and asset limits based on the Federal Poverty Level (FPL). For 2022, a single applicant must have an income of no more than $30,276. Many sources count towards the income limit, including employment, alimony payments, pensions, Social Security disability, Social Security and stock dividends. In a single-person household, the asset total is $2,000. For a two-person household with only one person applying, the remaining spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance under the spousal impoverishment rule, which aims to ensure that the remaining senior has enough money to live on. In a two-person household with both seniors applying, the asset limit is $3,000.
2022 Medicaid Income Limits for Seniors in Florida
|Two-Person Household(Only One Person Applying)||$30,276 per applicant||$2,000 for applicant$137,400 for non-applicant|
|Two-Person Household(Both People Applying)||$30,276 per applicant||$3,000|
Additional Eligibility Requirements:
- Resident of Florida
- Citizen of the U.S. or legal alien
- 65 years of age or older
- A need for nursing home level care
Applying for Medicaid in Florida
Seniors applying for state Medicaid may apply online through ACCESS Florida or by calling (850) 300-4323. To apply through the mail, download the application, fill it out and mail it to ACCESS Central Mail Center, P.O. Box 1770, Ocala, FL 34478-1770 or fax it to (866) 886-4342 or any local Department of Family and Children’s Services Office.
Before You Apply:
Before applying for Florida Medicaid, be sure to have all the important documentation on hand.
- Birth certificate
- Proof of citizenship or qualified alien status
- Social Security Number
- Government-issued ID
- Copies of bank statements for the past 60 days
- Copies of income for the past 60 days
- Copies of property ownership, including deeds and titles
- Copies of insurance policies
- Retirement award letters
Where to Go to Get Help
Seniors who need assistance applying for Florida Medicaid can contact one of the agencies below. They can also provide updates on applications and answer questions about state benefits.
|Florida Department of Children and Families||(850) 300-4323||The Florida Department of Children and Families has trained caseworkers who can assist seniors in applying for state benefits, including Medicaid.|
|Benefits.gov||(800) 610-1863||Benefits.gov is a federal website that provides a starting point for information about state and federal benefits. By contacting the toll-free number, seniors can get answers about Medicaid, including how to apply and eligibility information.|
|Florida Health||(800) 342-3556||Florida Health is operated by the Florida Department of Health to answer questions regarding state benefits. The agency’s vision is that health belongs to everyone and fostering a healthy culture requires the participation of everybody in the state. Programs and services offered by Florida Health include insurance counseling, education and free health assessments.|
Can You Use Medicare to Pay for Assisted Living in Florida?
Unfortunately, Medicare does not cover the cost of assisted living in Florida. Unlike nursing homes, assisted living facilities are not considered to be “clinical settings’ and so are not eligible for Medicare coverage. That being said, you can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.
For more information about what Medicare visit medicare.gov.
Are There Other Financial Assistance Options for Assisted Living in Florida?
|Aid and Attendance||Apply online at va.gov.||If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.|
|Reverse Mortgages||Research and learn about the different types at ftc.gov||If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.|
|Long-Term Care (LTC) Insurance||Learn about how to receive LTC insurance benefits at acl.gov.||While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.|
Free and Low-Cost Resources for Seniors in Florida
Florida has multiple free resources that help seniors improve their quality of life by addressing common needs. Some of these resources are regional, while others are from statewide agencies that provide everything from transportation to insurance counseling.
|Seniors Resource Association||(772) 569-0760||The Senior Resource Association is a nonprofit organization that promotes a healthier lifestyle among seniors. These programs include home-delivered and congregate meals, transportation, adult enrichment, health and fitness and case management.|
|Department of Elder Affairs||(850) 414-2000||The Florida Department of Elder Affairs promotes the safety, well-being and welfare of seniors, their families and caregivers. Programs and services include transportation, elder protection, guardianship, community support, disaster preparedness, food assistance and emergency home assistance.|
|Senior Resource Alliance||(800) 963-5337||The Senior Resource Alliance is a nonprofit funded by the Federal Older Americans Act that serves individuals aged 60 and older. The agency is involved in the planning, coordination, development and evaluation of services, including an elder helpline, job assistance, health and well-being programs and telephone reassurance.|
|Florida Council on Aging||(850) 222-8877||The Florida Council on Aging serves older adults through education, information sharing and advocacy. The agency’s website also includes a list of resources and publications with answers to some of the most common questions about aging.|
|Florida Department of Veterans’ Affairs||(727) 319-7440||The Florida Department of Veterans’ Affairs helps men and women who’ve served in the military locate benefits and compensation to which they are entitled. The agency also helps seniors apply for the Aid and Attendance benefit that helps pay for activities of daily living in long-term care facilities.|
COVID-19 Rules for Assisted Living in Florida
The following information is based on research done on several government websites, including floridahealthcovid19.gov and cdc.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 2/3/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.
Visiting Loved Ones
|Can I visit my relative in person if he/she wants emotional support from me?||Yes (Conditions Apply)|
|Can I visit my relative in person for end-of-life compassion care?||Yes|
|Will my loved one be required to self-quarantine after I visit him or her?||No|
|Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?||Yes|
|Are Hairdressers and other non-medical contractors still allowed in senior living facilities?||Yes|
|Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?||Yes|
|Are visitors being screened for elevated temperatures?||Yes|
|Are visitors being asked questions about health, travel, and potential virus contact?||Yes|
Outings and Group Activities
|Are residents allowed to leave the facility for non-medical reasons?||Yes|
|Are residents of senior living facilities who leave and return required to self-quarantine?||No (Conditions Apply)|
|Are senior living facilities required to cancel all group outings?||No|
|Are residents still eating together in the dining hall?||Yes|
|Are facilities still allowed to host group activities within the community?||Yes|
Safety Measures for Staff & Contractors
|Are staff members and contractors being screened for elevated temperatures?||Yes|
|Are staff members and contractors being tested for Coronavirus?||Yes|
|Are staff members and contractors being asked questions about health, travel, and potential virus contact?||Yes|
Safety Measures for Residents
|Are staff members required to regularly screen residents for coronavirus symptoms?||Yes|
|Are residents relied on to screen themselves and self-report potential coronavirus symptoms?||No|
|Are staff members required to take residents’ temperatures?||Yes|
|Are residents being tested for coronavirus?||Yes|