If you are a senior who is struggling with the physical and/or mental deterioration that comes along with the natural aging process you may reach a point where it becomes unsafe for you to care for yourself without help. Understandably, however, you do not want to leave your home and move to a long-term care facility. By the same token, you don’t like the idea of someone you don’t know caring for you. The Port St. Lucie Medicaid planning attorneys at Kulas Law Group explain how you may be able to choose your caregiver as a Medicaid recipient in Florida.
Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC)
In 2013, Florida deployed a Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC) system, also referred to as a nursing home diversion program, to meet the needs of their elderly residents. Under this program, Medicaid eligible seniors who require long term care supports can receive assistance in their home, in the community, or in assisted living. SMMC LTC divides Florida into 11 regions with six different Managed Health Care Organizations that provide services. Not every provider is available in all 11 regions.
How Does the SMMC LTC Program Work?
If you are deemed eligible, the first step is to select a “Plan” from one of the providers who offer care in your geographic area. That provider becomes responsible for all of your long term care needs. You will still receive your medical services coverage through Medicare or another private insurance policy. Once you have selected a plan, you are assigned a Long Term Care Case Manager who conducts a comprehensive assessment of your care needs. Family members and other persons knowledgeable about you 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 you can receive care (for example at home, in adult day care, assisted living, an adult family care home, or a nursing home) and what care and supports you require in that environment.
Your plan will have a network of care and service providers to fulfill all of your long-term care needs. In addition, there is a degree of ‘participant direction.’ This Participant Directed Option (PDO) means you will have some choice in who provides you with care services, at a minimum in the areas of personal care and homemaker services. You (or a representative, such as a friend or relative) will be able to hire, train, and manage the care provider. The best part is that family members, including adult children and even spouses, can be hired and receive compensation as providers.
Am I Eligible for the SMMC LTC Program?
You must meet all the following criteria to participate in the SMMC LTC program:
- Be a legal Florida resident
- Be a minimum of 65 years of age OR be between 18 and 64 years old and designated as disabled by the Social Security Administration
- Need “nursing facility level of care”
- Meet the financial requirements for Florida Medicaid
How Is “Nursing Facility Level of Care” Defined?
While you must need “nursing facility level of care” to participate in the SMMC LTC program, that doesn’t necessarily mean that you need nursing or skilled medical services. Florida uses a standardized in-person exam to understand the degree to which the applicant needs assistance or partial assistance to complete two or more activities of daily living. Examples include bathing, personal hygiene, eating, and mobility. In the case of Alzheimer’s and dementia care patients who do not have any physical limitations, the state also recognizes the need for supervision of individuals who have several memory impairments.
Are You Financially Eligible?
The financial eligibility rules for Medicaid are complicated and subject to change each year. Both your income and assets will be evaluated and you must be below both limits. In 2019, the individual limit for an applicant is $2,313 per month. For couples, when both parties are applying, the joint income limit is $4,626 / month. When only one spouse applies and the other does not, the Medicaid spousal impoverishment rules come into play and eligibility gets even more complicated. In short, the spouse that does not need care can claim most of the income. This is called the Monthly Maintenance Needs Allowance, or MMNA, and as of 2019, you can transfer up to $3,160.50 a month of your income to your spouse if you are applying for benefits.
The asset limit for a single applicant is $2,000, and the limit for a married couple, with both spouses applying, is $3,000. Once again, if you are applying but your spouse is not, the asset rules get more complicated. As of 2019, your non-applicant spouse can retain up to $126,420 of your joint assets. This is called the Community Spouse Resource Allowance. Keep in mind that some assets are exempt, meaning they do not count when calculating the value of your assets for eligibility purposes.
What Services Are Available in the SMMC LTC Program?
Although not all participants will be eligible for all services, the list of services offered by the program is lengthy. Services marked with asterisk can be participant directed, meaning you can decide who provides the care.
- Adult companion care*
- Adult day health care
- Adult family care home / Adult foster care
- Assistive care services
- Assisted living
- Attendant nursing care*
- Behavioral management
- Care coordination/ Case management
- Caregiver training
- Home accessibility adaptation
- Home-delivered meals
- 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
Contact a Port St. Lucie Medicaid Planning Attorney
To learn more, please join us for an FREE upcoming seminar. If you have additional questions or concerns about long-term care or Medicaid planning, please contact an experienced Port St. Lucie Medicaid planning attorney at Kulas Law Group by calling (772) 398-0720 to discuss your legal options.