IMPORTANT NOTICE - August 2011: Florida Medicaid Diversion program is open.

There is a waiting list, and if you are not on the list, you must call the Cares department to register.

If you already have  nursing home Medicaid - Medicaid Institutional Care Program (ICP) and you have been residing in a nursing home for at least 60 days, you can switch to Medicaid Diversion (without waiting for the program to open or be on the waiting list) and move in an assisted living facility. You can do so by calling Cares Department.

• What Is Medicaid Diversion?

• How Much Medicaid Diversion Pays?

• Does Medicaid Diversion Pay For Services Provided At Home?

• What Are Managed Care Organizations?

• Resident Qualifications

• Meet Level- Of- Care Criteria

• Assisted Living Facility Qualifications

• Selecting An Assisted Living Facility?

• What Is Medicaid ICP?

• What Is Medicaid Diversion?

  • The Long-term Care Community Diversion Program is a Medicaid waiver program designed to provide community-based services to people who would otherwise qualify for Medicaid nursing home placement. The services provided by the Diversion Program include a variety of long-term care services and Medicaid-covered medical services. The objective of the Diversion Program is to provide frail elders with safe, appropriate community-based care alternatives in lieu of nursing home placement, at a cost less than Medicaid nursing home care.
  • Medicaid Diversion will provide Medicaid benefits to the elderly at home or pay for part of the assisted living facility monthly costs.
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• How Much Medicaid Diversion Pays?

  • Unlike Medicaid at the nursing home level, Diversion pays a lump sum amount and does not offer full coverage of care or medications. The premise behind the program is to allow those who would otherwise qualify for skilled nursing (or nursing homes) to live in an assisted living facility where they can be safely cared for at a reduced cost to the state. Unfortunately funding is often depleted before everyone is served and there is a long wait list maintained by the Department of Elder Affairs in Tallahassee.
  • The program may pay $800 to one facility and $1200 to another. This amount covers all services and is deducted from the total room rate. If the difference is more than the resident’s income the facility has the right to ask the resident to pay the difference- but only for the room- not for services.

   

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• Does Medicaid Diversion Pay For Services Provided At Home?

  There is no monetary compensation given by Medicaid Diversion to you if you are in your own home. Monetary compensation is given only if you are receiving care in an assisted living facility. However, there are services offered to you in your own home by the Medicaid Diversion such as a home health aide (caregiver) to assist you with activities of daily living, for an hour or two per day (maximum of 15 hours per week), they will provide you with supplemental drinks (Ensure, Glucerna, Nephro, etc) and incontinence supplies (diapers), social worker services and more.

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• What Are Managed Care Organizations?

  • Managed care organizations and other qualified providers (such as Amerigroup, AmericanEldercare, Tango-Citrus, Universal, Evercare, Vista) enter into a contract with the State and receive a capitated payment to provide, manage and coordinate a qualified enrollee's full continuum of care. Generally speaking, the managed care organizations provide care through contracted providers, which can include home health agencies and assisted living facilities.
  • The providers then contract with each individual assisted living facility and negotiate a rate whereby the facility agrees to provide the elder with the needed services. This rate is different depending on the provider and the room and board rate established by the facility. This amount covers all services and is deducted from the total room rate. If the difference is more than the resident’s income the facility has the right to ask the resident to pay the difference- but only for the room- not for services.
  • The providers (Amerigroup, Tango-Citrus, AmericanEldercare, etc.) each have a menu of additional services they may choose to provide, such as a medication stipend (to cover medication co-pays) or incontinence supplies. The resident has the right to talk to all providers and find the one that best suites their needs- they are only limited by the fact that each assisted living facility chooses who they wish to contract with. Some facilities work with only one provider, some work with all of them.
  • The assisted living facility can charge less than the contracted rate but cannot charge more.
  • For a list of managed care organizations, please contact the Department of Elder Affairs' Diversion Program at telephone number 850- 414-2000.
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• Resident Qualifications

  Individuals that meet the following criteria are eligible to receive services under the Diversion Program:

   

  • Be 65 years of age or older
  • Reside in a Diversion Project service area
  • Be a Florida resident
  • Be a U.S. citizen or qualified noncitizen
  • File for any other benefits to which they may be entitled
  • Disclose any rights to third party liability (i.e., health insurance)
  • Have Medicare part A and part B
  • Meet nursing facility level of care criteria and additional clinical criteria as determined by the Department of Elder Affairs' CARES Unit
  • Meet the income limit of $2022 for an individual or $4044 for a couple
  • Meet the asset limit of $2000 for an individual or $3000 for an eligible couple
  • If your monthly income exceeds $2022/month you still can benefit from Medicaid Diversion by setting up an income trust. This is a legal document and it must be done by an attorney
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• Meet Level- Of- Care Criteria

  You must meet the level-of-care as determined by the Department Of Elder Affairs CARES Unit.

  • Require some help with five or more activities of daily living (ADLs); or
  • Require some help with four activities of daily living (ADLs) plus need supervision or administration of medication; or
  • Require total help with two or more activities of daily living (ADLs); or
  • Have a diagnosis of Alzheimer's disease or other type of dementia, and require assistance or supervision with three or more ADLs; or
  • Have a diagnosis of degenerative or chronic condition that requires daily nursing services.

   

  The following are considered activities of daily living (ADLs):

  • Eating
  • Bathing
  • Dressing
  • Walking
  • Transfers
  • Toileting
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• Assisted Living Facility Qualifications

  • Any licensed assisted living facility in Florida may contract with a managed care organization to provide care under the Diversion Program.
  • Not all the assisted living facilities work with all Medicaid Diversion providers. Each facility has their preferred provider or providers. There are facilities that do not accept Medicaid Diversion at all.
  • Phoenix Senior Living is accepting Medicaid Diversion (Amerigroup, AmericanEldercare, Citrus-Tango, Universal and Vista).
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• Selecting An Assisted Living Facility?

  • You have to shop around for the best rate. Some facilities will accept the resident's income as full payment, some assisted living facilities will charge additionally for the room, and some facilities will charge less and the resident will have some income left over. It all depends on the negotiated rate set by the facility and by the provider, and of course the amount of resident's income available.
  • When talking to the assisted living facility, be very honest about the resident’s income and the family’s ability to cover additional costs. If the resident’s income is not sufficient, and the family cannot help, and the facility will not work with you on the rate, then you must go somewhere else. 
  • The negociated rate between the facility and the managed care organizations are for a semi-private (shared) room. If you are interested in a private room, you must inquire on the cost of a private room which, in most facilities, is higher than of a shared one.
  • Ask the facility if they are working with your chosen provider. Even if they are not, some facilities will be willing to contract with you provider in order to accept you in their facility. Or, you can change to a provider that the assisted living facility works with. The process is simple and the change can be done within a month.
  • Ask about additional services that the facility may charge you additionally, services that the facility is not obligated to provide under the Medicaid Diversion contract. 
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• What Is Medicaid ICP?

  Florida Medicaid Institutionalized Program (ICP), commonly referred to as The Nursing Home Medicaid Program, provides coverage for most of the costs of nursing home care for qualified individuals. The applicant must meet certain medical and financial criteria. The financial requirements are based on the "income cap" and "asset test" and are different for single people and for married people.

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