How much does medicaid pay for assisted living in florida

With a senior population of more than 5.2 million people, Florida has become one of the most elder-friendly states in the country. Though it is known for beachfront property and lovely, tropical weather, Florida may be most attractive to retirees due to the low tax obligations it places on seniors. Along with being one of seven states that do not levy a state income tax, Florida also has no inheritance or estate taxes, and does not tax Social Security income. Due to the many favorable conditions of life for the elderly in Florida, this state is replete with high-quality options for assisted living.

Directory of Assisted Living Facilities in Florida

Because finding the right facility can be difficult, we have simplified your research process by compiling our data into an easy to use directory. Below, you will find nearly 1,800 facilities in Florida listed with their relevant information, such as costs, amenities, and Medicaid acceptance status.

Paying for Assisted Living in Florida

The Cost of Assisted Living in Florida

The average cost of assisted living in Florida is favorable in comparison to most surrounding states. At $3,500, Florida costs are on par with facilities in South Carolina and Mississippi, and are generally less expensive than facilities in North Carolina. The only southeastern states where assisted living is cheaper are Alabama and Georgia, where average income and costs of living are also lower.

Costs of assisted living will vary in different regions of any state, usually skewing higher in more population-dense city centers. Cost variation in Florida can be significant, with the most popular cities for retirement, like Naples, being some of the country’s most expensive areas for assisted living. If Florida’s most populated cities are excluded from the state average, the remaining counties have an average cost of only $3,000 per month.

The type or level of assistance that is needed will usually affect an individual’s costs for care. For example, in contrast to Florida’s average costs of assisted living, nursing home prices in the state are extremely high, approaching $10,000 per month. Home healthcare and memory care services are likely to cost an average of $400 more than assisted living.

Financial Assistance for Assisted Living in Florida

Florida’s Long-Term Care Waiver

While Florida’s Medicaid plan doesn’t directly cover the cost of assisted living, it does offer the Long-Term Care Waiver that can be used to help pay for care received in an assisted living community. Services that may be reimbursed include personal care to assist residents with activities of daily living, such as eating, personal grooming, and basic mobility. The list of services now covered under this waiver can be found in the Agency for Healthcare Administration’s LTC Waiver Snapshot.

Who is Eligible?

In order to qualify for long-term care coverage under the SMMC, applicants must meet the following eligibility requirements:

  • 65 or older
  • Resident of Florida
  • Currently enrolled in Medicare Parts A and B
  • Assessed by CARES to be nursing home-eligible
  • A monthly income of $2,250 or less (300% of the Federal Benefit Rate)
  • Assets amounting to no more than permitted by Institutional Care Programs
  • Have applied for all other benefits for which one may qualify

The Long-Term Care Waiver is a non-entitlement program, so it can only support a limited number of active participants. Interested parties should apply to be added to the waiver’s waitlist as long in advance as possible.

How to Apply

Florida employs a special program to provide need assessments of people seeking long-term care Medicaid coverage. The program is called CARES, which stands for Comprehensive Assessment and Review for Long-Term Care Services. Anyone who wishes to receive Medicaid reimbursement for assisted living services must undergo assessment.

After assessments have been completed, CARES staff or case managers at the Area Agencies on Aging can help applicants get on the waitlist for services. To initiate an assessment, visit one of 17 CARES field office locations, or contact your local Area Agency on Aging. AAA office locations can be found by using the directory included below.

PACE

The Program of All-Inclusive Care for the Elderly is a national network of state-selected providers who offer services on a regional level. The goal of PACE is to provide total medical coverage for especially frail seniors who would otherwise have to be institutionalized to continue receiving Medicaid. The program covers services, medicines, equipment, and medical procedures that are intended to meet most, if not all needs of very frail seniors.

Services may be provided by a personal care aide or nurse employed by an assisted living facility, or by home health aides under contract with the resident. Participants who are ineligible for Medicaid may be covered by PACE, but must pay a fee for service. The fee covers a long list of Medicaid-subsidized services, and represents a lower cost than nursing home residence in the state of Florida.

Who is Eligible?

People who are 55 or older may be eligible for PACE if they qualify for Medicaid and require a nursing home level of care. PACE is a non-entitlement program with limited enrollment, so only a certain number of people who live within the locale of a PACE service provider can be covered. Fortunately, there are more provider locations in the state of Florida than almost any other state, and each location can support from about 150 to 300 active participants. It is recommended that interested parties add their names to the PACE waitlist as far in advance as possible.

How to Apply

To apply contact one of the PACE service locations in Florida found in the table below, or get in touch with your local Area Agency on Aging. To find out if you live in a PACE service area or to contact a provider near you, call (855) 435-7223. For more information, visit flPACE.org.

More Ways to Finance Assisted Living

Some additional ways to finance assisted living costs include:

  • Veterans Benefits: Veterans can take advantage of several different pension programs to help cover the cost of assisted living. For more information, see the article on benefits.va.gov.
  • Life Insurance Policies: Even if a spouse or loved one hasn’t died, certain types of life insurance policies can be used to pay for assisted living. More information is available at longtermcare.acl.gov.
  • Long-Term Care Insurance: Long-term care insurance is a type of insurance policy that pays for long-term care when it becomes necessary, including the cost of assisted living. For more information on the benefits and drawbacks of this financing method, visit longtermcare.acl.gov.
  • Reverse Mortgages: Reverse mortgages allow seniors to access the equity from a home that they own, and these funds can be used to pay for assisted living. The U.S. Department of Housing and Urban Development offers a federally insured reverse mortgage program.

Free Assisted Living Resources in Florida

The Medicaid Non-Emergency Transportation (NET) Waiver

Florida assisted living facilities are required to provide transportation for residents who are unable to do so for themselves. However, this is usually a paid service, and getting from one place to another can represent an added cost that Medicaid recipients may not be able to afford. The Medicaid Non-Emergency Transportation Waiver reimburses providers of transportation for rides to both medical and non-medical destinations for non-emergency trips. This can include rides to scheduled doctor’s visits, personal business needs, and general errands.

To find out more, visit the Agency for Healthcare Administration online. A waiver fact sheet can be found at AHCA.myflorida.com.

The Department of Elder Affairs maintains a helpline for seniors in need of advice regarding civil (though not criminal) law. The helpline is free to use, and provides appointment scheduling to people over 60 years of age who wish to speak with a Florida legal professional over the phone. Services that the helpline provides include free legal advice and briefing, referrals to state and local regulatory agencies, and help finding legal council when court representation is needed.

The Senior Legal Helpline can be reached by calling (888) 895-7873. To find out more, visit ElderAffairs.state.fl.us.

SHINE

Administered by the Department of Elder Affairs, SHINE (Serving the Health Insurance Needs of Elders) is a network of office locations that function much like Aging and Disability Resource Centers. The main difference is that SHINE trains volunteers to assist elders specifically with concerns related to Medicare, Medicaid, or health insurance. Services at SHINE are always free and confidential, and meetings can be arranged in person or over the phone.

To find out more about SHINE, visit them online at FloridaSHINE.org, or contact them at (800) 963-5337.

Florida’s Long-Term Care Ombudsman Program

Florida’s ombudsman program is operated by the Department of Elder Affairs. The Department organizes volunteer ombudsmen to advocate for residents of long-term care facilities, including people living in ALFs. An ombudsman will visit regularly with ALF residents to field their complaints and concerns, and to ensure that their facilities maintain the terms and conditions agreed upon in the residential service agreement and plan of service documents.

Florida’s Long-Term Care Ombudsman Program can be contacted via traditional mail at 4040 Esplanade Way in Tallahassee, FL 32399. They can also be reached at (888) 831-0404 (toll-free) or (850) 414-2323.

Complaints can be filed online by visiting Ombudsman.MyFlorida.com/Complaint, and more information on what the program offers is available at Ombudsman.MyFlorida.com.

Veterans’ Affairs

The VA may offer various means of financial support to veterans and their families who are seeking an assisted living arrangement. Eligible veterans may receive pensions, VA loans, additional pension benefits, and a broad range of social services. Interested parties should contact the VA Regional Benefits Office or the Regional Loan Center, which both occupy the same building.

Applicants for assistance may visit the St. Petersburg Regional Benefit Office at 9500 Bay Pines Blvd., St. Petersburg, FL 33744, or call (800) 827-1000. A complete list of VA contacts can be found online at the Department of Veterans’ Affairs’ Inquiry Routing & Information System (IRIS).

The Department of Elderly Affairs

The Department of Elderly Affairs is a department of Florida’s state government, and works with the Area Agencies on Aging to administer most state programs concerning the elderly. This department offers a long list of social and financial services with the goal of helping seniors remain as active and independent as possible. Services they offer include caregiver respite, transportation, intergenerational social programs, adult protective services, and the administration of multiple helplines providing resources and information.

Visit the Department of Elder Affairs online to view a complete list of free support programs for seniors. The Department can be contacted by calling (800) 963-5337, or by locating your local Area Agency on Aging in the directory below.

Area Agencies on Aging

The AAA is a network of regional offices commissioned by the Federal government to provide program development, information, and resources to seniors at the local level. In many states, the Area Agencies on Aging are also referred to as Aging and Disability Resource Centers, and in the state of Florida, these Agencies work closely with the Department of Elder Affairs. The goal of the Agencies is to facilitate access to care and to reduce confusion in the long-term care coverage arena.

For information relevant to the aging, local AAA offices may be a Florida citizen’s greatest available resource. Consult the directory below to find the AAA location serving your region.

Because Florida is one of 37 states that do not tax Social Security benefits, these benefits are an especially important part of Florida retirees’ income. Many tasks related to Social Security, such as finding information about benefits and eligibility, can be completed online at SSA.gov. People who desire personal assistance with their Social Security needs may consult the alphabetically-sorted directory below to find the Social Security office in their local area.

Assisted Living Laws and Regulations in Florida

Assisted living facilities in the state of Florida are licensed and regulated by the Agency for Healthcare Administration. To maintain their licensure, all facilities are required to meet certain regulatory standards, and to undergo periodic audits to ensure their continued legality.

Assisted Living Service Plans

Within a new tenant’s first month of residence at an assisted living facility, they must undergo a medical examination and then meet with facility staff or administration to establish a service plan based on the results. The service plan is intended to be a record of a resident’s needs and expectations at the facility, including medical needs such as medication dosage and frequency, or physical needs regarding things like emergency evacuation assistance.

This document serves as the facility’s systematic plan for how it will meet the needs of the resident. Service plans are to be updated every 30 days upon re-evaluation provided by a nurse or physician. Accompanying the service plan will be the residential agreement, which demonstrates that new residents have been informed of their rights, responsibilities, and costs to be expected at the facility.

Assisted Living Admission Requirements

Florida assisted living facilities (ALFs) may only accept new tenants if they are equipped to meet each resident’s needs. ALFs can generally admit people who are able to participate in social and leisure activities, who can walk around with minimal assistance, and who can perform most activities of daily living, such as eating and bathing, with only minimal assistance.

Facilities cannot accept individuals who require the use of restraints or who represent a danger to themselves or others. Those who need 24-hour nursing care, who are bedridden, or who require complete assistance with most of their activities of daily living also cannot be accommodated. Additionally, certain conditions or illnesses may disqualify an individual from residence. These are conditions which signify that a person is likely to become significantly debilitated to the point where they may need round-the-clock, or total assistance.

Assisted Living Scope of Care

All facilities in the state of Florida must obtain a Standard license to operate legally, which allows facilities to provide things like limited medication assistance, housing, promotion of social engagement, and basic assistance with activities of daily living, such as bathing, dressing, and eating.

In addition to the Standard license, other licensure, such as the Limited Nursing Services, Limited Mental Health, and Extended Congregate Care (ECC) licenses, may be obtained to allow facilities to provide greater assistance with activities of daily living and mental health care. The ECC license provides the greatest level of assistance for people with physical or mental disabilities and dementia-related illnesses. Properly licensed facilities may also admit home healthcare agencies to assist residents with greater care needs. Obtaining extended licensure allows seniors to age in place rather than being relocated if their health or mental capacity should begin to deteriorate.

Assisted Living Medicaid Policy

Florida Medicaid doesn’t directly finance assisted living. However, there are several programs that do reimburse for personal care services received in an assisted living facility. Nursing home-eligible residents may have their personal care services, such as assistance with activities of daily living, reimbursed under Florida’s Long-Term Care Waiver program. Florida Medicaid also administers a large PACE program, and facilities licensed to accept Medicaid may accept especially frail seniors who are covered under PACE. It’s important to note that Florida residents aren’t entitled to receive funding from these programs, and the number of participants is limited – so not everyone who qualifies will be able to take advantage of the funding provided.

Room and board costs at Florida ALFs are not capped for Medicaid recipients as they are in some other states. Instead, costs for room and board, and also for services are negotiated by the managed care provider through which a resident receives their Medicaid waiver services. For recipients of SSI, an $80 optional state supplement is provided, and the amount they are expected to pay to their ALF is set at $775.

Assisted Living Facility Requirements

Florida ALFs must meet certain logistical requirements to ensure that residents live in a positive, accessible, and home-like atmosphere. The state allows facilities to provide either private apartments or single- and multiple-occupancy bedrooms within shared spaces. Both types of lodging require lockable doors, full-use kitchens, a minimum of square footage, and accessibility features for people with reduced visual and functional capacity.

Private assisted living apartments must provide at least 80 square feet per resident. Multiple-occupancy rooms can accommodate no more than two residents and must have a minimum of 60 square feet of usable space per person. If a room is multiple-occupancy, at least 35 feet of living and dining space must also be provided per resident. Bathrooms may be shared, but at least one lavatory and one bathing area must be provided per every six and eight residents, respectively. In facilities licensed to provide Extended Congregate Care, bathing areas can only be shared by up to four occupants.

Medication Management Regulations

Licensed nurses make up part of the staff at Florida ALFs that have extended licensure, including Limited Nursing Service and Extended Congregate Care licensed facilities. Nurses can legally administer a consenting resident’s medication for them if the resident is unable to do so for themselves. Unlicensed personnel, or Direct Care staff, may go so far as to help a resident self-administer their medicines.

Assistance with the self-administration of medicines can include the staff member reminding an individual to take their medicines, helping to get packages open, or reading labels for residents. However, direct care staff may only do this, if they have completed six hours of medication-specific training at the start of their employment, to be reinforced with an additional two hours of training per year. Furthermore, Direct Care staff may only assist with the self-administration of medicines that are regularly prescribed and routinely taken. For limited use medicines and for injections, only a registered nurse can provide assistance with self-administration.

Staffing Requirements

All assisted living facilities in Florida must employ direct care staff, and must keep enough staff on the grounds to meet the needs of their populations. Florida employs staff-to-resident ratios to ensure that the service plans of residents can be accommodated. A minimum number of weekly employee hours must be maintained by the facility, and this number will be based on the number of people in residence.

Facilities that have Limited Nursing Care or Extended Congregate Care licensing must have a nurse on staff who can provide medication administration and other services. In facilities that have Extended Congregate Care licensure to house disabled or mentally handicapped individuals, either an administrator or supervisor must be assigned to the management of that facility’s Extended Congregate Care program. Staff in ECC units will be specifically trained to care for residents with specific disabilities and residents with dementia or related mental health issues.

Staff Training Requirements

On becoming an ALF employee, direct care staff take a two-hour training orientation that includes curriculum organized by the Department of Elder Affairs.

Administrators of ALFs must have a high school diploma or GED and must pass a competency test within 90 days of employment. The training required for administrators includes a minimum of 26 hours of training on topics related to the health and safety of residents. Every two years, an administrator must undergo an additional 12 hours of training on topics related to the management of a long-term care facility.

At facilities that have Extended Congregate Care (ECC) licensure to accommodate disabled or mentally compromised residents, additional training is required on top of that which staff and administrators in Standard facilities must undergo. Direct care staff in ECC facilities must have an additional two hours of in-service training within six months of hire on topics related to the special needs of ECC residents. ECC administrators and supervisors require an additional six hours of training regarding ECC populations, to be completed within 90 days of hire, and every two years they must take six hours of continued training.

Background Checks for Assisted Living

Extensive background checks are required of Florida ALF employees, administrators, owners, and board members. A fingerprint scan is used to search the databases of the FBI and the Florida Department of Law Enforcement. Due to the large size of the pool of long-term care workers in Florida, this state takes measures to carefully review background reports on an individualized basis, and to deliberate on the significance of any potentially disqualifying marks. A person cannot be professionally associated with an ALF if they have any past convictions or substantiated reports of violent behavior, abuse, neglect, or exploitation.

Reporting Abuse

The Agency for Healthcare Administration advises that before lodging a complaint of an assisted living facility, residents first take the matter to facility administrators. If no resolution can be reached, then the Agency for Healthcare Administration can receive complaints of long-term care facilities which fail to meet state requirements or fulfill their contractual obligations to care recipients. Their online complaint form can be found at apps.AHCA.MyFlorida.com, or at the Agency’s healthcare provider complaint portal at fHealthComplaint.gov. The AHA can also be reached by dialing (800) 955-8771.

For the reporting of suspected elder abuse, concerned parties should contact Adult Protective Services using the Florida Abuse Hotline, which is administered by the Department of Children and Families. Find them online at MyFLFamilies.com, or call toll-free at (800) 962-2873. A reporting form can be downloaded by visiting DCF.state.fl.us.

Florida COVID-19 Rules for Assisted Living Facilities

Note: The following information was compiled and most recently updated on 2/3/22. Since COVID-19 is a rapidly evolving crisis, be sure to contact your assisted living facility or local Area Agency on Aging for the most up-to-date information.

COVID-19 Rules in Florida

Are loved ones allowed to visit residents in their assisted living community?

Yes (Conditions Apply)

Are residents required to quarantine after their loved ones visit?

No

Are loved ones required to wear masks when visiting residents?

Yes

Are Hairdressers and other non-medical contractors allowed in assisted living communities?

Yes

Are visitors screened for elevated temperatures before entering the assisted living community?

Yes

Are residents allowed to leave the assisted living community for non-medical reasons?

Yes

Are residents who leave required to quarantine when they get back to the assisted living community?

No (Conditions Apply)

Are assisted living communities required to cancel all group outings?

No

Are assisted living communities allowed to host group activities within the community?

Yes

Are staff members regularly checked for elevated temperatures?

Yes

Are staff members regularly tested for COVID-19?

Yes

Are residents regularly screened for COVID-19 symptoms?

Yes

Are residents regularly checked for elevated temperatures?

Yes

Are residents regularly tested for COVID-19?

Yes

Sources: floridahealthcovid19.gov www.cdc.gov

*Note: This information was not available for this state, contact your local area agency on aging or senior living facility for more information.

Does Medicaid in Florida pay for assisted living?

In Florida, Medicaid can be used to pay for an elderly relative's nursing home, assisted living facility, or in-home nursing care. Medicaid pays a fixed daily rate to cover costs such as a patient's room, meals, staff care, and medical supplies, possibly for the remainder of their life.

How much is monthly assisted living in Florida?

Assisted Living Cost by State (Updated January 2022).

What is the maximum income for Medicaid in Florida?

Who is eligible for Florida Medicaid?.

How is most assisted living care usually paid for?

Most families use private funds to pay for assisted living. This means a combination of personal savings, pension payments, and retirement accounts. Though many seniors save for retirement over the years, family members often contribute to elder care costs.