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What is Florida Medicaid Managed Care?

Woman Disability Beach

Florida’s Statewide Medicaid Managed Care (SMMC) program is the program through which most Medicaid recipients receive Medicaid services. The SMMC includes three different programs: The Managed Medical Assistance (MMA) Program, the Long-term Care Program (LTC), and the Dental Program. MMA covers medical services like doctor visits, hospital care, and transportation to these services; most Medicaid recipients will receive care through plans that cover MMA services. The Dental Program covers dental healthcare. The LTC program has additional nuances and eligibility requirements, which we discuss below. Call a knowledgeable West Palm Beach Medicare planning and elder law attorney with any questions.

Florida’s Statewide Medicaid Managed Care Long-Term Care Program

The SMMC Long-term Care Program is a nursing home diversion program meant to meet the needs of elderly or disabled Florida residents. Seniors who are eligible under Medicaid and require long-term care can receive assistance in their homes, in the community, or in assisted living spaces. Different regions within Florida have different Managed Health Care Organizations that provide services to eligible residents.

A senior who requires care and is eligible will select a “plan” from one of the providers in the geographical region. The provider will then be responsible for the participant’s long-term care needs. The ideal plan will provide the patient with the necessary treatment in the least restrictive environment appropriate for the recipient; for example, living at home rather than living in an assisted-living facility where medically appropriate. Family members can even be hired and compensated for providing services for their eligible elderly family members.

Eligibility Requirements for Florida Medicaid Managed Care Long-Term Care Program

Not all elderly Florida residents qualify for SMMC. In order to obtain long-term care services under SMMC, a candidate must meet the following requirements:

  • Must be a legal Florida resident
  • Must be at least 65 years old, or between 18 and 64 years old and designated as disabled by the Social Security Administration
  • Must need “nursing facility level of care”
  • Must meet the financial requirements to obtain Florida Medicaid

“Nursing facility level of care” does not necessarily require that an applicant needs round-the-clock nursing care. An applicant must need at least partial assistance to complete two or more activities of daily living (ADLs). ADLs include the basic activities necessary for independent living, covering things like personal hygiene, eating, dressing, basic mobility, and maintaining continence (use of a restroom).

Plan for Your Medicaid Eligibility

A dedicated West Palm Beach Medicaid planning attorney can help you and your family plan appropriately to maximize your chances to qualify for Medicaid and other needs-based governmental programs. If you are in need of an experienced and effective Florida Medicaid planning and elder law attorney, contact the West Palm Beach trust and estates attorneys Shalloway & Shalloway at 561-686-6200.

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