Florida Medicaid Resources

• State Medicaid Website: Florida
• Florida Developmental Disabilities Council Website
• The Arc of Florida

Florida Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 469,400 people with disabilities using Medicaid in Florida. Florida spent $11,677 on each Medicaid recipient with a disability in 2007.

17% of the people covered by Medicaid in Florida have a disability, while the national percentage is 15%.

The state spends 43% of all of the money spent on Medicaid on services for people with disabilities, while the national percentage is 42%.

Florida Coordinated Non-Emergency Transportation

This program provides adults and children with disabilities with transportation for non-emergency medical needs.

• Community: Transportation (medical)

Managed Health Care

Florida’s Managed Care program consists of a Mental Health component, a Disease Management component, a Primary Care component, a Managed Care component, and a Dental component. These different programs provide a wide variety of services to children and adults with disabilities. You may not always be able to choose your service provider under this plan.

• Health: dental, disease management, mental health services

Florida Medicaid Reform

This program is a pilot program the state is doing to try out new changes it thinks will improve Medicaid service. Coverage under this plan might not be the same everywhere. This program allows children and adults with disabilities access to basic medical services. You may not always be able to choose your provider under this plan. People who are covered under an HCBS waiver or who are living in nursing or intermediate care facilities are not eligible.

• Health: chiropractic, dental, disease management, community mental health services, durable medical equipment, early and periodic screening, diagnosis and treatment, family planning, hearing, immunization, mental health, substance abuse treatment, occupational therapy, physical therapy, physician, podiatry, private duty nursing, skilled nursing facilities, speech therapy, vision, x-ray
• Home: home health care
• Social Services: targeted case management

Comprehensive Adult Day Health Care Program

This program provides services to older adults, including those with disabilities, who need daily care. This program does not cover people who are also eligible for Medicare or those who have any other insurance or are enrolled in another managed care program.

• Community: adult day care, non-emergency transportation
• Health: nutrition, rehabilitation, skilled nursing facility services
• Home: personal care
• Social Services: social services, case management

Nursing Home Diversion Program

This plan is designed to provide community-based services to older adults in order to allow them to live at home instead of in a nursing facility. This program does not cover anyone younger than 65, but it does cover anyone who is also eligible for Medicare.

Ages: 65 and older

• Community: escorts
• Health: dental, emergency care, hearing, hospice, hospital services, laboratory, occupational therapy, pharmacy, physical therapy, physician services, respite care, skilled nursing facilities, speech therapy, vision, x-ray
• Home: family training, home health care
• Social Services: financial assessment and risk reduction

Program of All-Inclusive Care for the Elderly (PACE)

PACE programs are designed for people 55 and older who might need nursing home placement, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary. Services are provided through PACE centers, so people must live close enough to an approved center to be eligible.

Ages: 55 and older

Restrictions: You must have access to a PACE center.

• Community: day care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs
• Home: home health care, home and environmental modifications
• Social Services: social services

Aged and Disabled Adult waiver

This waiver applies to adults with permanent disabilities who require the kind of care that would otherwise be provided in a nursing home. This waiver helps pay for that care to be given in a home setting.

Level of Care: nursing

• Community: adult day health care
• Health: respiratory therapy, skilled nursing, nutrition
• Home: attendant care, homemaker services, in-home respite care, personal care, home delivered meals, home pest control services
• Social Services: case management, financial risk assessment

Assisted Living for the Elderly (ALE) waiver

This waiver helps pay for certain services for people who already reside in assisted living facilities. It is designed to help people remain in these community settings instead of moving to nursing homes.

Ages: over 65 (people with or without disabilities) or over 60 (people with disabilities)

• Community: social and recreational services
• Health: incontinence supplies, behavior management, medication help, nursing, occupational therapy, physical therapy, specialized medical equipment and supplies, speech therapy
• Home: attendant care, chores, companion services, homemaker services, personal care
• Social Services: case management

Traumatic Brain or Spinal Cord Injury

This waiver serves people who have brain or spinal cord injuries and would otherwise require nursing home care.

Ages: 18 and older

Level of Care: Nursing

Restrictions: There are only about 300 slots for this waiver, and there is a waiting list.

• Community: adaptive health and wellness
• Health: assistive technologies, behavioral programming, consumable medical supplies, counseling, rehabilitation
• Home: attendant care, adult companion, environmental modifications, personal care
• Social Services: life skills training, support coordination

Model waiver

This waiver serves people who have a genetic disease that affects their brain or nervous system. They must require a level of care that would keep them in a hospital, and this waiver will help provide that care in their homes instead.

Ages: 20 and under

Restrictions: There are only 5 slots for this waiver, so there is often a waiting list.

• Health: assistive technology
• Home: environmental modifications, respite care
• Social Services: service evaluation

Developmental Disabilities waiver—Tiers 1-4

Florida’s DD waivers have different criteria and provide different services according to a person’s needs. Although this system is complicated, it is designed to help get people the services they need.

Ages: older than 3

Level of Care: Intermediate

Tier 1: People eligible for Tier 1 must have intensive medical, behavioral, or adaptive needs.

Tier 2: People receiving Tier 2 services must live in a residential facility and require more than 5 hours a day of habilitation, or must live in supported living arrangements and require more than 6 hours a day of in-home support.

Tier 3: People with developmental disabilities who do not meet the criteria for Tiers 1 or 2 are eligible for some Tier 3 services.

Tier 4: Tier 4 services are available to people with developmental disabilities who live in their family home, their own home, or a foster home.

Services provided for Tiers 1, 2, and 3:

• Community: adult day training, transportation
• Health: dental, behavior analysis, behavior assistants, dietician services, medication review, personal emergency response systems, private duty nursing, skilled nursing, medical equipment and supplies, mental health services, occupational therapy, physical therapy, respiratory therapy, speech therapy
• Home: companion services, environmental accessibility modifications, in-home support, residential habilitation, residential nursing, personal care, respite care, specialized medical home care, supported living coaching
• Social Services: support coordination
• Work: supported employment

Services included in Tier 4 are:

• Community: adult day training, transportation
• Health: behavior analysis, behavior assistants, personal emergency response systems, medical equipment and supplies
• Home: environmental accessibility adaptations, in-home support, respite care, supported living coaching
• Social Services: support coordination
• Work: supported employment

DD Individual Budgeting waiver (iBudget)

The individual budgeting waiver was approved in 2011 and may eventually replace the tier system, in which spending is set at a certain amount for each person for each year. This waiver will allow spending to be calculated according to each person’s individual needs, and will be able to change if a person’s medical situation changes.

Options for Self-Direction: One idea of this waiver is to give you more control over your money, and a voice in what services you want to spend it on.

• Community: transportation
• Health: dental, occupational therapy, physical therapy, private duty nursing, skilled nursing, specialized medical equipment and supplies, mental health counseling, speech therapy, behavioral analysis and therapy, dietician services, personal emergency response systems
• Home: residential habilitation, respite, environmental accessibility modifications, family or caregiver training, personal supports, residential nursing, supported living coaching
• Social Services: life skills development, support coordination