Florida Medicaid's Nursing Home Diversion (NHD) Waiver
What are Medicaid Waivers?
Medicaid pays for long term care services in nursing homes. For nursing home qualified persons that choose to live at home or in a residential community, Medicaid will pay for those services if they can be obtained at a lower cost. These are called Home and Community Based Services, Waiver Funded Services, Medicaid Waivers or simply Waivers.
The Florida NHD Medicaid Waiver is designed to help frail seniors stay at home instead of moving into nursing homes. It has been found to be more cost effective for the state to allow nursing home qualified persons to live at home and utilize family caregivers as a primary caregiving resource. Generally, this model of care is also preferred by the healthcare consumer and family members.
This program allows participants to select a case manager and a county-approved managed care organization (or HMO) that will provide them with medical and custodial care services in their homes. Note this waiver is also referred to as the Long-Term Care Community Diversion waiver.
Waiver Eligibility Guidelines
This waiver has relatively rigid requirements for eligibility. In addition to being 65 years or older, candidates must be eligible for Medicare A & B
and be financially qualified for Medicaid.
Florida Medicaid's 2013 income limits are $2,130 for an individual applicant or $4,260 for a married couple. Their "countable assets" which includes any savings but does not include a home or primary vehicle must be less than $2,000 for an individual or $3,000 for a couple.
Persons whose financial resources exceed these limits have two options to still qualify for Medicaid. They can participate in Florida's Medically Needy program, which requires them to spend-down their income or assets on their care until they become financially eligible. Alternatively, they can choose to work with a Medicaid planning professional who will re-allocate their financial resources into the appropriate exempt annuities and trusts so that they become Medicaid-eligible. Find Medicaid planning assistance.
Finally, from a medical perspective, the applicant must require the same level of care typically provided in a skilled nursing home but they cannot choose to live in that environment. It is worth noting that they can live in an assisted living community.
Services / Benefits
The Nursing Home Diversion waiver, as the name implies, is designed to divert individuals from nursing homes. As such, the pool of benefits and services provided under this waiver are selected to help individuals remain living at home or in the homes of caregivers. Final benefits are determined on a case-by-case basis during enrollment in the program and can include the following:
-Adult Day Health
-Assisted Living Services
-Consumable Medical Supplies
-Environmental Accessibility Adaptation
-Nutritional Assessment/Risk Reduction
-Personal Emergency Response Systems
-Respite Care (for their primary caregivers)
-Nursing Facility Services (on a temporary basis)
How to Apply / Program Availability
As of January 2013, this waiver was not available statewide but services were being provided in 46 counties. These include:
|Alachua, Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, DeSoto, Duval, Escambia, Flagler, Glades, Hardee, Hendry, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Leon, Manatee, Marion, Martin, Miami-Dade, Monroe, Nassau, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, Volusia, Walton and Washington.
One can read more about this waiver on the Florida Elder Affairs webpage
. One can apply by contacting their local Area Agency on Aging or by contacting the Florida Department of Children and Families
Use our Locator Tool to Find Other Options for which You're Eligible
Page Reviewed / Updated - Jan 2013