Senior woman sitting in wheelchair at nursing home

What Medicaid Covers in the Nursing Facility

In 2001, the Florida legislature created a new program called Statewide Medicaid Managed Care (SMMC). There are two different parts that make up the SMMC program.

The Managed Medical Assistance (MMA) program. Health care services offered through this program are:

  • Physician services, doctor visits, and Physician assistant services
  • Prescription drugs
  • Hospital inpatient services
  • Hospital outpatient services
  • Emergency services
  • Ambulance services

The Long – Term Care (LTC) Program. This program covers the room and board for a semi­ private room in a nursing facility.

Once Medicaid is approved the state will mail the Medicaid recipient a letter notifying him/her as to whether or not he/she is required to enroll in the SMMC MMA program. Please visit [email protected] to view the various Florida Participating Managed Care providers. This website will assist on how to choose a plan, specialty plan information, various regions, and Florida’s frequently asked questions.

Now that my father has been approved for Medicaid in the nursing home will he be required to drop his Medicare coverage?

No. The SMMC (Statewide Medicaid Managed Care) program will not change his Medicare benefits at all.

Great. But what about his Medicare supplement? Will he be required to drop that?

No. He may elect to keep it if he wishes. His patient Liability (income payment) to the facility will be reduced by the amount of his Medicare supplemental premium. In other words, Medicaid allows for his income to cover that expense while paying the balance of his gross income (minus $130.00 for personal needs) to the facility. This is optional. If he elects to drop his supplement (or doesn’t have one) the SMMC program will cover his medical and room and board expenses.

Is there a separate11Medicaid wing” in the nursing facility that only care for individuals on Medicaid?

No. Absolutely not. All patients when placed long term are in semi-private rooms regardless if they are Medicaid, paying privately or have Long Term Care Nursing insurance.

If I move my mother to another nursing facility in Florida will she have to go through the application process again?

No. Just make sure the facility she is moving to has a female Medicaid bed available.

How often does Medicaid review income and asset balances after approval?

Typically, there is a one-year review. Usually the nursing facility can provide this information to the Medicaid case worker. Remember, there should be no build up of assets. The income flows through the bank account (Social Security can be directly deposited to the nursing facility) monthly then paid to the facility so there is no opportunity for monies to add up unless an exempt piece of property is sold or an inheritance has been received. If this should occur, please call LTCS, LLC as soon as possible, so Medicaid benefits are not jeopardized.

Will I receive an itemized bill from the nursing facility for the items not covered by Medicaid for my wife’s care, such as diapers, aspirins, bandages etc.?

No. Medicaid covers all auxiliary expenses related to your wife’s care in the facility.

My father has been in a nursing facility for a year under Medicaid. My brother and I just sold his home for $90,000.00, will he now be bumped off Medicaid?

Yes. Without immediate planning to protect his funds, he will be bumped off Medicaid. Call the Long Term Care Solutions, LLC team to avoid jeopardizing his monthly Medicaid benefits. The same situation is true if your father should receive money from an inheritance.These assets need to be addressed as soon as possible so not even one month of Medicaid is lost.