Florida’s Aged and Disabled Adult (ADA) Medicaid Waiver

Page Reviewed / Updated - Feb. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

As of March 1, 2014 Florida discontinued all Medicaid HCBS Waivers relevant to the elderly for long term care. Seniors now receive assistance from the Statewide Medicaid Managed Care Long Term Care (SMMC LTC) Program. Learn more here.

This Florida Medicaid waiver is designed to help the elderly and permanently disabled adults. It is intended specifically to allow persons at risk for nursing home placement to remain living in their homes or in the homes of their caregivers and to receive assistance in those locations.  A wide variety of supports are offered to both the individual in need of care and their primary caregivers or family members.  In additional to personal care,  adult day care and respite enable caregivers, such as the adult children, to work and care for the aging parent.  Home modifications budgets can increase the recipient's ability to maintain their independence.

This program is very similar in design and objective to the Nursing Home Diversion (NHD) Waiver. However, there are two key differences. The NHD Waiver's services are provided by managed care organizations instead of by the state. This waiver is open to individuals younger than 65 if they are disabled. The NHD Waiver is only available to persons aged 65 and older.

This waiver does not allow for self-direction, however individuals that wish to self-direct should also qualify for the Consumer Directed Care Plus Waiver.

 

Eligibility Guidelines

To qualify, there are functional or disability requirements and financial requirements. The functional requirements change with age. For persons under 65 years of age, they must be disabled and certified as such by the Social Security Administration. For individuals 65 and older, full disability is not required however, they must at a minimum, require nursing home level care.

Financially, ADA Waiver participants must qualify for Florida Medicaid which considers applicant's income and financial resources. In 2014, the individual limit for an applicant is $2,163 / month. For couples, when both parties are applying, the joint income limit is $4,326 / month. However, when one spouse is applying and the other is not there is increased flexibility with regards to income. The spouse who is not applying is allowed to keep sufficient income to enable her or him to continue living independently. In this situation, couples can allocate their joint income to the healthy spouse and to help the spouse that requires assistance to qualify for Medicaid.

Consideration of financial assets or resources works in a similar manner. Individuals are allowed up to $2,000 in "countable resources", and couples are permitted up to $3,000. However, if one spouse is not seeking Medicaid, then they are permitted up to $117,240 in resources. If they continue to live in their home, then the home is considered an exempt asset and its value is not put towards the resource limit.

Persons whose assets or incomes exceed the Medicaid limits or couples where only one spouse requires Medicaid should strongly consider finding Medicaid planning help to ensure they qualify and that the healthy spouse has adequate income and resources to continue living independently. Find assistance applying for Medicaid.

 

Benefits and Services

The Aged and Disabled Adult Waiver's objective is to help person remain living at home and accordingly, the benefits of this waiver are selected with that objective in mind. During enrollment, applicants are assessed to determine their care requirements. They can be approved for any of the following care benefits:

  • Adult day health care
  • Attendant care
  • Case management
  • Chore services
  • Disposable medical supplies
  • Durable medical equipment
  • Home delivered meals
  • Homemaker services
  • Nutritional risk reduction (counseling)
  • Personal care
  • Pest control
  • Respiratory therapy
  • Respite care
  • Skilled nursing (however not for long term)

 

How to Apply / Learn More

Long waiting lists to receive services under this waiver should be expected.

This waiver is open to Floridians statewide.  Be aware that waiting lists for services are the norm. In 2013, despite assisting over 11,000 persons, there were approximately two applicants for every one slot available.  Some limited additional information is available about this waiver on the Department of Elder Affairs website.

To apply, persons under 60 years of age should contact the Florida Department of Children and Families. Persons 60 and older should contact the Department of Elder Affairs.