Getting on the LTC Waiver

Like all HCBS Waivers, the LTC Waiver caps enrollment which, in Florida, results in a long waiting list. To get on the LTC Waiver, most people need to first be screened for the waiting list. You will not be able to enroll until you have a priority ranking high enough to be “released” from the waiting list.

STEPS TO LTC WAIVER ENROLLMENT

STEP 1: ARE YOU ELIGIBLE?

Age 18 and over and eligible for Medicaid due to a disability, or age 65 and over; and

Needing a nursing home level of care (or hospital level of care for persons with cystic fibrosis).

Although both clinical and financial eligibility for Medicaid are not determined until release from the waiting list, it’s a good idea to begin to review financial eligibility in particular with an attorney who has expertise in Medicaid planning.

STEP 2: GET SCREENED FOR WAITING LIST PRIORITY

With limited exceptions, you or someone on your behalf will need to schedule a phone screening with your regional Aging and Disability Resource Center. Screeners use Form 701S to ask questions about the applicant’s condition and care needs. Some responses are used to determine priority ranking for the waiting list.

This screening does NOT determine clinical eligibility or financial eligibility. Both of these are assessed when released for enrollment.

STEP 3: UNDERSTANDING YOUR PRIORITY RANKING

You have the right to know your priority rank and can ask the screener for the rank (1-5) when the screening concludes. You can also ask the ADRC later and for a copy of your responses and raw score. A rank of 5 typically results in release for the waiting list. A rank of 1 or 2 will not even get you on a waiting list. Rankings can be challenged in a fair hearing, but you can also ask to be rescreened if there are significant changes to your condition or circumstances.

STEP 4: WHEN RELEASED FROM THE WAITING LIST, DOCUMENT ELIGIBILITY

Being released from the waiting list doesn’t mean automatic enrollment. You still must apply for Medicaid (if you aren’t already on Medicaid) and verify clinical and financial eligibility. This involves:

  • Completion of a Form 3008 by your physician to certify your level of care

  • A face-to-face clinical assessment using Form 701B, which is a longer version of the screening tool. This is done by the DOEA CARES Division in your region.

  • Completion of a Medicaid application through ACCESS for review by DCF for financial eligibility. This usually requires submission of proof of income and assets.

STEP 5: PICK A MANAGED CARE PLAN

Once approved, you will be asked to pick a managed care plan in your region. Periodically, contracts are re-bid and regions can change. Your selection of a plan is made by contacting Choice Counseling at 1-877-711-3662.

If you do not select a plan, one will be selected for you automatically.

You can change plans during annual open enrollment periods or if you can show “cause” why you need to disenroll in your managed care plan.

STEP 6: PROACTIVELY LEARN ABOUT SERVICES

Once you are enrolled, the plan will assign a case manager who will schedule a visit to go over a bundle of documents with you and develop a Plan of Care. This Plan of Care is supposed to be “person-centered” and guided by your goals to give you the array of services you need to stay in your home or community.

At this meeting, you can be overwhelmed with information if you don’t take the time to learn about the services (see Getting LTC Waiver Services) that are offered first. You can have anyone at your care planning meeting that you would like to support you and offer guidance.