Florida Assisted Living for the Elderly 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

The Assisted Living for the Elderly (ALE) Waiver helps elderly Floridians that are assessed to require significant assistance with the activities of daily living and desire to receive that care in an assisted living residence instead of in a nursing home. Nursing homes are significantly most costly than assisted living communities. The state of Florida recognizes this fact and can save money by allowing individuals that would prefer to reside in assisted living residences to do so. Thus a win-win situation is created; the state saves money and the individual requiring care has a preferable living situation.

It is worth noting that should ALE Waiver participants' conditions decline to a point where the cost to provide services in assisted living exceeds the cost to provide the same services in a nursing home, then they may be required to leave assisted living and move to a skilled nursing home.

In 2014, this waiver has the capacity to serve approximately 5,000 persons.  Unfortunately even at that level it is very normal for waiting lists to exist.

Did You Know? Free assistance is available to help Florida residents find assisted living within their means. Get help here.

 

Eligibility Guidelines

Eligibility for the ADA Waiver is determined on three levels: age, functional ability and financial resources.

Age and Functional Ability
Persons under 60 are not eligible regardless of their functional ability. Persons between the ages of 60-64 are eligible if they are considered disabled by Social Security. Persons aged 65 and older qualify if assistance is needed for four or more activities of daily living such as bathing, toileting or grooming. Individuals that do not require this level of assistance but are diagnosed with Alzheimer's or other progressive conditions may also qualify.

Financial Restrictions
To qualify, applicants must meet the financial limits set for Florida Medicaid. Florida consider both the applicant's (and their spouses, if married) incomes and assets. The monthly income limits this year (2014) for an individual and couple respectively are $2,163 and $4,326. If one spouse is applying for Medicaid and the other spouse is not, income can be shifted to the non-applicant to help the applicant qualify.

The assets limits for an individual and couple are $2,000 and $3,000 respectively. However, these numbers are somewhat misleading for several reasons. First, not every asset is considered a countable asset. For example, one's home and primary vehicle are not counted provided they are being used and are not idle investments. Second, if one spouse is not seeking Medicaid, the asset limit rises dramatically to $117,240. Third, there are other techniques utilized by Medicaid planning professionals that help to convert assets from countable to exempt.

 Persons who do not meet the financial requirements but still cannot afford their cost of care should consider contacting a professional Medicaid planner to help them qualify.  Read more.

 

Benefits and Services

Waiver participants are provided with a case manager who helps to determine their needs and the services for which they are qualified. In addition to case management, this waiver can provide for any of the following:

  • Attendant Care
  • Behavior Management
  • Chore Services
  • Companion Services
  • Medication Administration Assistance
  • Durable Medical Equipment
  • Disposable Medical Supplies
  • Personal Care
  • Medical Equipment
  • Physical Therapy
  • Social and Recreation Services
  • Transition Assistance (from nursing homes)

 

How to Apply / Learn More

Unlike nursing home care, Medicaid funded, assisted living is not an entitlement and wait lists are the norm.

The Assisted Living Waiver is available statewide, however interested applicants should be aware that unlike other institutional Medicaid programs, this is not an entitlement. One may meet all the eligibility requirements only to find that there are no available slots and they are put on a waiting list for services.  In 2013, for every two persons receiving services, a third was on the waiting list.

This waiver is managed by the Florida Department of Elder Affairs. One should contact them or their local Area Agency on Aging to learn more and determine if a wait list exists in their geographic area.