If you have a loved one being cared for in a skilled nursing facility (SNF) under Medicaid but he or she is better suited for an assisted living facility (ALF) they may be able to transfer to an ALF and qualify for Medicaid benefits without having to be on a waiting list. Unfortunately, the Medicaid program that pays for the ALF has a long wait list but individuals applying for the nursing home (ICP) Institutional Care Medicaid Program has no wait list. So, the ability to qualify for Medicaid benefits in a SNF and then move to an ALF under Medicaid is significant.

This rule is called the “60-day Transition Rule”. As long as an individual in a SNF is on Medicaid for at least 60 days he or she can move to an ALF who accept Medicaid and maintain the Medicaid benefits in the ALF. If the rules for this program are not followed exactly, the Medicaid services can be lost and the individual placed on a wait list for the Medicaid diversion programs. For this program to work, the applicant must have been in a SNF for 60 consecutive days. Next, the applicant (or his or her representative) must contact the Cares Unit (comprehensive assessment and review for Long Term Care services http://elderaffairs.state.fl.us/doea/elder_helpline.php) in their area to open the transition case. The cares case worker will determine whether the person can safely be discharged to an ALF. The Medicaid application must be approved in the SNF before the person can transition to the ALF and avoid being placed on a waiting list.

An ALF provides room and board and personal care services such as, help with dressing, moving, bathing, taking medication and general care of the physical and mental wellbeing. An ALF can be covered by Florida’s Statewide Medicaid Managed Care Program. Each SMMC Program will contract with its own providers, so not every ALF will be covered under every plan. It’s important to choose the SMMC Program that covers the facility you are interested in.

Limited Home Health Care Under Medicaid

When working with the Statewide Medicaid Managed Care Program (SMMCP) it is also possible to coordinate limited home health care benefits as well. The home health care provided is NOT 24-hour care, but it can offer some nursing assistance to the Medicaid recipient, as well as relief to any caregivers/family members providing care to their love one.

Are Medicaid qualifying guidelines “income and asset limitations” the same for nursing home and Alf’s?

Yes.The most recent Medicaid qualifying numbers, (refer to the Medicaid At A Glance card or visit https://longtermcaresolutionsllc.com/medicaid/) income and asset limits are the same guidelines to pass whether looking to qualify for the nursing home Institutional Care Program (ICP) or ALF diversion program.

What is the best way to move my father into an ALF from the SNF?

First, he will need to meet a certain physical and mental level of care. ALF’s usually offer different levels of care and service, which reflect the monthly price to the individual. As more care is rendered by the facility the cost goes up. If your father meets the health level required to move into an ALF you will want to make sure he transitions under the “60-day transition program” so he does not lose his Medicaid benefits. Before making a move into an ALF review the participating managed care providers and communicate with the ALF admissions coordinator to ensure a smooth transition.

Is it possible for my husband to come home from the nursing facility with home health care assistance under Medicaid?

Yes.The same rules apply under the “Transition Program” (See page 17.) You will work with a case manager from the Statewide Medicaid Managed Care Program you have chosen from the nursing facility, to transition home with limited home health care to assist your husband’s health needs.

Call our office today and we can recommend a home health care agency working with the Statewide Medicaid Managed Care Program providing health care at home under Medicaid.