Florida Medicaid's Nursing Home Diversion (NHD) 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

 This program covers all a participant's medical and custodial care needs including Medicare deductibles and co-payments.

The Nursing Home Diversion Waiver is designed to help frail seniors stay at home instead of moving into nursing homes.  To avoid any confusion, it should be mentioned that this program is also referred to as the Long-Term Care Community Diversion Pilot Project.

This program allows participants to select a case manager and a county-approved managed care organization (sometimes called an HMO) that will provide them with all their medical and custodial (non-medical) care services in their homes as well as pays for their Medicare co-insurance and deductibles.

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 than to pay for full nursing home costs.   In almost every case, this model of care is also preferred by the healthcare consumer and their family members.

 

Eligibility Guidelines

 There are functional ability, age and financial requirements to participate in this program.

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 2014 income limits are $2,163 for an individual applicant or $4,326 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.  Persons with Alzheimer's or dementia do not automatically qualify but do so if they also require assistance with multiple activities of daily living and supervision. 

 

Benefits and Services

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, in the homes of caregivers or in senior living residences.  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
  • Case Management
  • Chore Services
  • Consumable Medical Supplies
  • Environmental Accessibility Adaptation
  • Home-Delivered Meals
  • Homemaker
  • Nutritional Assessment/Risk Reduction
  • Personal Care
  • Personal Emergency Response Systems
  • Respite Care (for their primary caregivers)
  • Nursing Facility Services (on a temporary basis)
  • Transportation Assistance

 

How to Apply / Learn More

Meeting all the eligibility requirements does not guarantee space will be available.

As of February 2014, this waiver was not available statewide but services were being provided in 66 of 67 Florida counties.   In 2013, almost 25,000 Florida residents received assistance under this program.  However as it is a pilot program, meeting all the eligibility requirements does not guarantee space will be available for all qualified candidates. 

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.