How The ALF/In-Home Waiver Programs Work
The State of Florida offers various Medicaid programs, each providing recipients with different benefits based on the specific program. The Florida Medicaid Home and Community-Based Services (HCBS) Long-Term Care Waiver Programs help pay for long-term care medical expenses for the elderly, disabled and other eligible individuals. These waiver programs operate under a 1915(c) waiver from the federal Centers for Medicare and Medicaid Services (CMS), and aim to offer more flexible, community-based care options which allow seniors and individuals with disabilities to avoid placement in a skilled nursing facility (nursing home) and either seek placement in an assisted living facility (ALF) or remain in their homes with appropriate care services provided by the state. These waiver programs are part of the Statewide Medicaid Managed Care (SMMC) program, which is administered by the Florida Agency for Healthcare Administration (AHCA), the Department of Children and Families (DCF), and local county Area Agencies on Aging.
As an elder care law firm, Feldman & Feldman, Counsellors at Law, P.A., provides comprehensive support for families facing the challenges of caring for an elderly or disabled loved one while qualifying them for public benefits. Families often struggle to find the necessary support when it becomes unsafe for the loved one to remain at home. Typically, the family is left struggling to navigate the complexities of Medicaid rules and regulations without knowing where to turn for accurate information and counsel. For almost 35 years we have helped hundreds of clients with Medicaid planning needs and we stand ready to assist with qualifying your loved one for ALF Medicaid benefits and the in-home waiver program, as well as assisting with a host of other elder care issues. In addition to Medicaid qualification, we assist the Medicaid applicant with protecting their hard-earned recourses with the goal of avoiding a total “spend down” of assets to qualify them for benefits; these resources are then available to supplement the individual’s Medicaid benefits or pass on as a legacy to the Medicaid recipient’s intended beneficiaries.
Purpose And Goals of the Waiver Program
The primary goal of the ALF and in-home waiver programs is to allow individuals who require long-term care to receive services in a less restrictive environment than a nursing home. This approach promotes independence and improves the quality of life for participants by enabling them to stay in their own home or an assisted living facility.
Determining Eligibility
To qualify for these programs, individuals must meet specific criteria:
- Age and health requirements: Applicants must be 65 years or older or 18 years or older and eligible for Medicaid due to a disability. They must also require a nursing home level of care, as determined by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) program.
- Financial criteria: Applicants must meet Medicaid’s financial eligibility requirements, which consider income and asset limits.
The Agency for Health Care Administration caps enrollment in the ALF and in-home waiver programs, and there is typically a waitlist for services due to high demand and insufficient funding. The waitlist is managed by the Florida Department of Elder Affairs in conjunction with local Area Agencies on Aging (in Broward County, the Aging and Disability Resource Center – ADRC – manages the waitlist). The program prioritizes individuals based on their level of need via a screening interview with the applicant or their caregiver. We assist our clients with preparing for this screening interview with the goal of obtaining a placement score that will minimize the applicant’s time on the waitlist.
Upon being released from the waitlist, the Medicaid applicant then has 30 days to submit an ACCESS Florida Medicaid application with the Department of Children & Families. Our office also handles submission of this Medicaid application from beginning through to a Notice of Case Action determining the applicant’s eligibility for benefits. The Medicaid applicant need not be financially eligible for Medicaid upon their placement on the waitlist, but they must be eligible by the time they are removed from the waitlist and their Medicaid application is submitted. This often provides a window of time for us to work with the applicant and their family to prepare and implement a Medicaid plan with the goal of protecting the applicant’s resources while also qualifying them for benefits.
Services Provided
The ALF and in-home waiver programs offer a wide range of services to support participants in their daily lives. These services include:
- Personal care: Assistance with activities of daily living (ADLs) such as bathing, dressing and grooming.
- Medical services: Skilled nursing care, medication management and administration services.
- Therapies: Physical, occupational and speech therapy to help maintain or improve functional abilities.
- Support services: Case management, caregiver training and respite care to support both participants and their families.
Are the ALF and In-Home Waivers Right For Your Family?
Florida’s ALF and in-home waiver programs provide essential support for seniors and individuals with disabilities, allowing them to receive care in more comfortable and familiar settings. The legal team at Feldman & Feldman, Counsellors at Law, P.A., provides ongoing support and guidance, helping families navigate the often confusing and overwhelming world of elder care. Call 954-228-6074 or contact the firm online to schedule an appointment with our elder care lawyers today.