Florida Medicaid Home Care: How the Programs Work
Florida operates home care programs for low-income adults who need long-term services and supports to remain in their homes. The main structure is the Statewide Medicaid Managed Care Long-Term Services and Supports program, known as SMMC-LTSS. Under this framework, the state contracts with managed care plans to coordinate and pay for home and community-based services.
Qualifying for Medicaid home care in Florida requires meeting two separate eligibility tests: a functional test based on the level of care the person needs, and a financial test based on income and assets. Both must be satisfied for enrollment to proceed.
Gifted Health Group Inc (AHCA License #299991488) accepts Florida Medicaid and Medicaid managed care plans and has served Miami Gardens, Miami, Hollywood, Homestead, and surrounding South Florida communities since 1997.
Florida’s SMMC-LTSS Program
Florida’s Statewide Medicaid Managed Care Long-Term Services and Supports (SMMC-LTSS) program is the framework through which eligible Floridians receive home and community-based care funded by Medicaid. The state contracts with managed care plans to coordinate and pay for long-term services.
Beneficiaries enrolled in SMMC-LTSS choose a managed care plan from those operating in their county. The managed care plan then authorizes services and contracts with licensed home health agencies to deliver care. All managed care plans must cover the same core set of services, but the specific amount, duration, and scope of authorized services may vary by plan based on the individual’s assessed needs.
Florida Community Care
Florida Community Care is a managed care plan operating under Florida’s SMMC-LTSS program. It provides home and community-based services to eligible adults who would otherwise require nursing facility care. Florida Community Care is one of the plans operating in Miami-Dade County, and Gifted Health Group is an authorized provider for Florida Community Care members in South Florida.
Other managed care plans operating in Miami-Dade County under SMMC-LTSS include Humana, Sunshine Health, Molina Healthcare, and Devoted Health, among others. Plan availability depends on the county of residence and changes based on state contracting cycles.
Who Qualifies for Medicaid Home Care in Florida
Eligibility for Florida Medicaid home care under SMMC-LTSS requires meeting two types of criteria: functional and financial. Both must be met.
Functional Eligibility: Level of Care
An applicant must require the level of care provided in a nursing facility. This does not mean the person must live in a nursing home. It means the person’s medical and functional needs are substantial enough that they would qualify for nursing facility placement if home-based care were not available.
Florida uses a standardized assessment to determine nursing facility level of care. The assessment evaluates activities of daily living, cognitive function, medical complexity, and behavioral conditions. A state-authorized assessor conducts this evaluation, typically in the applicant’s home.
Conditions commonly supporting a nursing facility level of care determination include advanced dementia, Parkinson’s disease, stroke-related functional impairment, multiple sclerosis, severe mobility limitations, and complex medical conditions requiring ongoing skilled or paraprofessional care. No single diagnosis automatically qualifies or disqualifies an applicant.
Financial Eligibility: Income and Assets
Florida Medicaid financial eligibility for SMMC-LTSS uses specific income and asset thresholds updated annually. For individuals applying in 2025, countable asset limits are generally $2,000. Married couples have different rules designed to protect a portion of assets for the community spouse.
Certain assets are excluded from the eligibility calculation. A primary home is generally not counted as a resource if the applicant intends to return home or a spouse or dependent relative lives there. One vehicle, personal property, and certain prepaid burial arrangements are also typically excluded.
Because the financial eligibility rules are detailed and change periodically, families are encouraged to consult with a Florida elder law attorney or a Medicaid planning specialist before submitting an application.
How to Apply for Florida Medicaid Home Care
The application process for Florida Medicaid home care involves multiple agencies and typically takes several months from start to enrollment.
Step 1: Apply through Florida DCF. The Department of Children and Families processes Medicaid applications in Florida. Applications can be submitted online through the ACCESS Florida portal at myflorida.com/accessflorida, by mail, or in person at a DCF service center.
Step 2: Provide required documentation, including proof of identity, Florida residency, Social Security number, income sources, and asset documentation.
Step 3: Complete the functional assessment. After DCF determines financial eligibility, the applicant is referred for a functional assessment by a state contractor to determine whether nursing facility level of care is met.
Step 4: Choose a managed care plan from those available in the county. If no selection is made within the specified period, the state may auto-assign a plan.
Step 5: The managed care plan conducts its own assessment, develops an individualized service plan, and authorizes services with a contracted home health agency such as Gifted Health Group.
The Waitlist Reality in Florida
Florida’s SMMC-LTSS and home and community-based services programs have historically operated waitlists. Demand for home-based services has consistently exceeded available slots in several programs, and wait times have ranged from several months to more than a year, depending on program and funding levels.
During the waiting period, families have two practical options: arrange private pay services while the Medicaid application is pending, or rely on family caregivers to provide care until Medicaid authorization is in place. Gifted Health Group provides private pay services during this waiting period and can transition clients to Medicaid-funded services once authorization is received, without disrupting the established care routine.
Services Covered Under Florida Medicaid Home Care
Core services generally available under SMMC-LTSS include home health aide services covering personal care, personal care aide services, companion services providing supervision and socialization, homemaking services for light housekeeping and meal preparation, respite care for family caregiver relief, and adult day health care. Managed care plans determine the number of authorized hours for each service category based on assessed needs.
Children and Florida Medicaid Home Care
Children with significant medical needs may qualify for home-based services through separate Medicaid programs, including Florida Medicaid Private Duty Nursing for medically complex children who require skilled nursing hours at home. Pediatric PDN covers skilled nursing for children dependent on ventilators, feeding tubes, or other medical equipment requiring ongoing skilled oversight.
Dual Eligibility: Medicare and Medicaid Together
Some Florida residents qualify for both Medicare and Medicaid. For dual-eligible individuals, Medicare covers skilled home health services such as skilled nursing visits, therapy, and home health aide visits during a skilled episode. Medicaid may cover additional personal care, companion, and homemaking hours that Medicare does not provide. Gifted Health Group is certified under Medicare and accepts Medicaid managed care plans, allowing the agency to coordinate care across both funding sources for eligible clients.
How Gifted Health Group Supports Medicaid Clients
Gifted Health Group has accepted Florida Medicaid and Medicaid managed care plans since its founding in 1997. Staff members communicate in English, Spanish, and Haitian Creole, and the agency is available 24 hours a day, seven days a week. The agency serves Miami Gardens, Miami, Hollywood, Homestead, and surrounding South Florida communities. For families waiting for Medicaid approval, Gifted Health Group offers private pay services and transitions clients to Medicaid-funded care once authorization is in place.