What is the Statewide Medicaid Managed Care Long-Term Care Program?
Providing Long-Term Care (LTC) services to Florida's most vulnerable citizens is a multi-agency effort. The Agency for Health Care Administration (AHCA) administers the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, sets coverage policy, and gets those eligible for services enrolled in a LTC plan. The Department of Children and Families (DCF) is responsible for determining financial eligibility for services. The Department of Elder Affairs (DOEA) is responsible for determining medical eligibility and level of care needed.
Community Care Support
The State Medicaid Managed Care Program provides community-based services, Assisted Living and Nursing Home assistance to frail functionally impaired seniors and disabled adults age 18 and above at risk of nursing home placement. The program assists clients to remain in their own homes or Assisted Living facilities. The program also manages clients under Long Term Care Medicaid in a Nursing Home. Clients must meet financial eligibility as determined by the Department of Children and Families and functional level of care as determined by CARES. Clients choose a Long-Term Care Managed Care Plan through an enrollment broker. The plan assigns a case manager to each client who will help develop a care plan.
All LTC plans offer these long-term care services:
- Adult Companion Care
- Adult Day Health Care
- Assistive Care
- Assisted Living
- Attendant Nursing Care
- Behavioral Management
- Caregiver Training
- Care Coordination/Case Management
- Home Accessibility Adaptation
- Home Delivered Meals
- Homemaker
- Hospice
- Intermittent and Skilled Nursing
- Medical Equipment and Supplies
- Medication Administration
- Medication Management
- Nutritional Assessment/Risk Reduction
- Nursing Facility
- Occupational Therapy
- Personal Care
- Personal Emergency Response System (PERS)
- Respite Care
- Physical Therapy
- Respiratory Therapy
- Speech Therapy
- Transportation to LTC Services
Step 1: Screening
The first step in getting services through the Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) program is getting screened by an Aging and Disability Resource Center (ADRC). A list of the ↗ADRC’s is available on the Florida DOEA’s website.
Or you can call the statewide toll-free Elder Helpline at 1-800-96-ELDER (1-800-963-5337).
The screening is done over the phone with the person and/or caregiver and takes about 45 minutes to an hour to finish. The screening yields a priority score and rank used for placement on the wait list to receive long-term care services.
- Contact Area Agency on Aging of Palm Beach / Treasure Coast, Inc. for a screening and assessment at 1.866.684.5885
- If you are outside the 5-County service area, click on the map to find your local resource center: ↗ Elder Affairs Resource Directory
- Disagree with your Screening Results? You can ask for a Fair Hearing.
Step 2: Eligibility
The role of the ADRC is to assist you with the eligibility process, including helping you fill out forms and answering questions you may have about the above eligibility steps.
Click ↗ Here to learn more about the pre-enrollment list release, priority scores, and ranks.
Please note that we cannot provide any legal advice or advice on the Medicaid eligibility determination process performed by the Department of Children and Families (DCF). The DCF Automated Community Connection to Economic Self Sufficiency (ACCESS) number is 1-866-762-2237 and the website is ↗ here.
You must meet medical and financial eligibility requirements. In order to meet those requirements, you will need to complete the following steps:
Step 1: Submit Form 5000-3008 within 30-days
This is the required Medical Certification form, also known as the Form 5000-3008. Please have your doctor complete the Form 5000-3008 as soon as possible. All highlighted sections are required and must be legibly completed. Please note that the form must be signed by your doctor, a Physician Assistant, or an Advanced Practice Registered Nurse.
Either you, your doctor, Physician Assistant, or Advanced Registered Nurse Practitioner can return the signed Form 5000-3008 to:
Area Agency on Aging of Palm Beach / Treasure Coast, Inc.
4400 N. Congress Avenue, Suite 250
West Palm Beach, Florida 33407
Fax: (561) 214-8670
If you need help getting the form completed, please call 1-866-684-5885 for assistance. If the completed form is not received, you will not be able to continue the eligibility process.
Step 2: Submit Medicaid Application to DCF
The Department of Children and Families (DCF) ACCESS Florida Medicaid application is the second step in the eligibility process and is required to determine your financial eligibility.
In preparation to receive help with completing the application, please begin to gather the following items as soon as possible:
- DCF Financial Information Release, which must be signed by the person applying;
- Identification (Social Security Card, Medicare ID, and Photo ID);
- Power of Attorney and DCF Designated Representative form, if applicable; and any
- Proof of income and assets (pensions, checking, savings, annuities and life insurances).
Please note that we can help with completing the application, but only DCF can determine whether you meet financial requirements. If you do not submit an Medicaid application to DCF, you will not be able to continue the eligibility process. Once the application is filed, it is important to quickly submit all the documentation that DCF requires.
Step 3: Complete a 701B Assessment with CARES
The Department of Elder Affairs’ CARES Program will contact you to set up a 701B assessment—completing step three in the eligibility process. The 701B assessment, in addition to the Form 5000-3008, helps CARES staff to see if you meet the medical eligibility that is required for program enrollment. If CARES staff is unable to reach you or unable to set up a time to complete the 701B you will not be able to continue the eligibility process.
Ask for a Fair Hearing about screening results or if you disagree with the eligibility decision
If a person believes the answers given to his or her screening were not recorded right, he or she can contact the ADRC at 1-866-684-5885 to request to update the screening or may ask for a Fair Hearing. If a person believes Comprehensive Assessment and Review for Long-Term Care Services (CARES) has denied medical eligibility in error, or the Department of Children and Families (DCF) has denied financial eligibility in error, he or she has the right to request a Medicaid Fair Hearing within 90 days of the notice. To request a Medicaid Fair Hearing, please write or call:
Fair Hearing by calling the Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970), or writing by:
Email here
Fax – (239) 338-2642
Mail – Agency for Health Care Administration Medicaid Hearing Unit
P.O. Box 7237 Tallahassee, Florida 32314-7237
Report a complaint ↗ Here
Step 4: Pick a Long-Term Care Plan (IF APPROVED)
Individuals for whom it has been decided are eligible to receive long-term care services (LTC) through the Statewide Medicaid Managed Care (SMMC) Long-Term Care program will receive a welcome letter and brochure with information about the SMMC program and how to select a plan from the Agency for Health Care Administration (Agency).
To select a different plan, the individual must make a plan choice by the date in the letter. SMMC plans by region are on the Agency’s Statewide Medicaid Managed Care website. Click here to view a map of regions and counties.
Choice counselors are available by phone at 1-877-711-3662 to help recipients select a plan that best meets their needs. In-person visits are available by request for recipients with special needs.
Recipients can also ↗enroll online.
Once enrolled in a plan, enrollees may change plans during the first 120 days of enrollment. After the 120 days, enrollees may only change plans during their once a year open enrollment period or with a State-approved good cause reason.