If you are a Florida senior, or if your loved one is a Florida senior, it’s important to know all the services that Florida Medicaid can cover, either in part or in whole, for Florida seniors. Generally as people move through their retirement years, they spend more and more of their savings and retirement income on healthcare related costs, including senior living and senior care. Given that senior living and senior care can often be quite expensive, it’s important to know all the ways in which government programs like Florida Medicaid can help you or your senior loved one pay for care. Florida Medicaid is a partnership between the federal government and the state of Florida which provides healthcare coverage to eligible Florida seniors, primarily through the Statewide Medicaid Managed Care Long-Term Care Program (also known as the SMMC LTC) and the Managed Medical Assistance Program (known as the MMA), as well as a Dental program.

Because every senior’s situation is unique, it’s important to consult with a Florida elder law or Florida Medicaid expert to confirm all the ways in which Florida Medicaid may be able to pay for your or your senior loved one’s senior living or senior healthcare. In order to get an idea of what services Florida Medicaid covers for senior and elderly Floridians, check out our guide below.

Florida Medicaid Overview

The vast majority of Florida seniors receive Medicaid coverage through Florida’s Statewide Medicaid Managed Care Program, which itself is broken down into three separate programs, each with their own eligibility requirements: Managed Medical Assistance, Long-Term Care, and Dental. One particular set of eligibility requirements to keep in mind is that a senior can only be enrolled in one plan at a time. This means that if a senior is eligible for both an MMA plan and a LTC plan, they must choose the LTC plan and receive care through their LTC plan. On the other hand, a senior who is eligible for a LTC plan cannot have their care covered by an MMA plan. Because of these and other eligibility requirements, it’s important to speak with a local Florida elder law attorney or Medicaid expert to understand what programs you or your senior loved one may be eligible for. 

Together, these three programs provide coverage for a wide range of care options for seniors in Florida, including preventative care, medications, and long-term care either at home or in a community setting. Read more about what each program in the Florida Medicaid Managed Care Program covers below. 

Medicaid Managed Care Long-Term Care Program

The Florida Medicaid program that you or your senior loved one are most likely to encounter, particularly if you or your senior loved one require long-term care in a nursing home setting, is Florida’s Statewide Medicaid Managed Care Long-Term Care Program. Established in 2013, Florida’s Statewide Medicaid Managed Care Long-Term Care Program provides coverage for Medicaid-eligible Florida seniors to receive long-term care either at home, or in a community or nursing home setting. 

In order to be eligible for Florida’s Long-Term Care Program a senior applicant must meet both a financial and a care based eligibility requirement. The financial eligibility requirement focuses on two broad categories, namely a senior applicant’s income and their assets. It’s important to consult a Florida financial planner or Medicaid expert to understand whether you qualify, and if not, if there are any ways for you to restructure your assets in order for you or your spouse to qualify for Florida Medicaid coverage. The care-based eligibility requirement focuses on determining whether an applicant requires a Nursing Facility Level of Care. This assessment generally focuses on the extent to which the senior applicant can accomplish all of their Activities of Daily Living, such as using the toilet, dressing, or preparing meals. 

Florida’s Statewide Medicaid Managed Care Long-Term Care Program covers a wide range of care options for eligible seniors that can be provided either at the senior’s home, or in a community setting. For Florida seniors who want to receive long-term care at home, the LTC Program provides services such as Adult Companion Care, where an individual comes for short periods of time to help with tasks around the house such as light housekeeping or meal preparation, or Intermittent and Skilled nursing, where licensed nurses come to a senior’s home to provide medical care such as providing injections or caring for a senior after a surgery. For Florida seniors who want care in a community setting, Florida’s Long-Term Care Program provides coverage both for adult day health care as well as stays in nursing or hospice facilities.  

Managed Medical Assistance Program

Florida seniors who need help covering health care expenses, but who do not qualify for the Statewide Medicaid Managed Care Longe-Term Care Program, may still qualify for coverage under Florida’s Managed Medical Assistance Program. Florida’s Managed Medical Assistance program provides access to a wide range of health care options, including many preventative treatments, such as doctor visits, hospital care, prescription drugs, and mental health care. In addition, MMA programs can also provide additional support services such as transportation to medical appointments. As noted above, MMA plans cannot provide services to Florida seniors who are eligible for Long-Term Care services as outlined above. For these seniors, they will receive all of their coverage through their LTC plan.

Dental Program

The third component of Florida’s Statewide Medicaid Managed Care Program is the Dental program, which provides coverage for preventative and therapeutic dental care for all Florida Medicaid recipients. All Medicaid recipients in managed care as well as all fully Medicaid eligible fee-for-service individual are required to enroll in a Florida Medicaid dental program. The Florida Medicaid Dental Program covers a wide range of dental care services for Florida seniors, including dental exams and screenings, dentures, fluoride, teeth cleanings and extractions, and dental x-rays.

To learn more about how Sunbound can help make paying for senior living and senior care more affordable for you or your senior loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and senior care, and we’re on a mission to make senior living and senior care more affordable for everyone.