Description:
In 2011, the Florida Legislature created a new program called the Statewide Medicaid Managed Care (SMMC) program. Because of this program, the Agency for Health Care Administration (AHCA) and Department of Elder Affairs changed how some individuals receive their long-term care from the Florida Medicaid Program.
There are two different programs that make up the Statewide Medicaid Managed Care:
- The Long-Term Care (LTC) Managed Care Program
- The Managed Medical Assistance (MMA) Program
Medicaid recipients who qualify and become enrolled in SMMC LTC will receive long-term care services from a long-term care managed care plan.
Services or Activities:
Each managed care plan contracted with AHCA to provide long-term care services must, at a minimum, provide the following services:
- Adult Companion
- Adult Day Care (Adult Day Health Care)
- Assistive Care Services
- Assisted Living Facility Services
- Attendant Care
- Behavior Management
- Caregiver Training
- Case Management
- Home Accessibility Adaptation
- Home Delivered Meals
- Homemaker
- Hospice
- Intermittent and Skilled Nursing
- Medical Equipment & Supplies
- Medication Administration
- Medication Management
- Nursing Facility Care
- Nutritional Assessment and Risk Reduction
- Occupational Therapy
- Personal Care
- Personal Emergency Response System
- Physical Therapy
- Respiratory Therapy
- Respite Care
- Speech Therapy
- Transportation
All of these services are available based on medical necessity, or they must be necessary in order to delay or prevent nursing facility placement.
Program Eligibility:
- Individuals that meet the following criteria are eligible to receive services under SMMC LTC:
- Age 65 and over and eligible for Medicaid
- Age 18 and over and eligible for Medicaid by reason of a disability
- Be determined by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit at the Department of Elder Affairs to be at nursing home level of care and meet one or more established clinical criteria.
- For more information about the Statewide Medicaid Managed Care Long-Term Care program, please visit the LTC website at: http://ahca.myflorida.com/Medicaid/statewide_mc/smmc_ltc.shtml
Independent Consumer Support Program:
The Independent Consumer Support Program (ICSP), is a coordinated effort by the Florida Department of Elder Affairs’ Bureau of Long-Term Care & Support (LTCS), working in collaboration with the statewide Long-Term Care Ombudsman Program (LTCOP), the local Aging and Disability Resource Centers (ADRCs), and AHCA. Florida’s ICSP operates using the staff of LTCS, local ADRCs, and the LTCOP to ensure that SMMC LTC consumers have multiple access points for information, complaints, grievances, appeals, or questions. Additionally, this three-pronged approach allows consumers a “no wrong door” access to the ICSP complaint resolution process, in addition to targeting the specific group who can best address a specific complaint, grievance, or question.
Additional SMMC LTC Information:
For additional SMMC LTC information, including a program overview and summary, please visit AHCA’s website at http://ahca.myflorida.com/Medicaid/statewide_mc/smmc_ltc.shtml.
For information regarding the LTC plans available in each region and how to choose an LTC plan, please visit the Choice Counseling website at www.flmedicaidmanagedcare.com.
For more information regarding the SMMC LTC waitlist, please contact your local Aging and Disability Resource Center. Click here for the direct contact information of the ADRC in your region. You can also call the statewide Elder Helpline at 1-800-96-ELDER for immediate assistance.
For assistance in addressing a complaint with your LTC plan, please visit AHCA’s website at http://ahca.myflorida.com/SMMC and click on the “Report a Complaint” button.
