Page Reviewed / Updated – October 19, 2020
As of March 1, 2014 Florida discontinued all Medicaid HCBS Waivers relevant to the elderly for long term care. Seniors now receive assistance from the Statewide Medicaid Managed Care Long Term Care (SMMC LTC) Program. Learn more here.
Waiver Description
The Assisted Living for the Elderly (ALE) Waiver helps elderly Floridians that are assessed to require significant assistance with the activities of daily living and desire to receive that care in an assisted living residence instead of in a nursing home. Nursing homes are significantly more costly than assisted living communities. The state of Florida recognizes this fact and can save money by allowing individuals that would prefer to live in assisted living residences to do so. Thus a win-win situation is created; the state saves money and the individual requiring care has a preferable living situation.
It is worth noting that should ALE Waiver participants’ conditions decline to a point where the cost to provide services in assisted living exceeds the cost to provide the same services in a nursing home, then they may be required to leave assisted living and move to a skilled nursing home.
In 2014, this waiver has the capacity to serve approximately 5,000 persons. Unfortunately even at that level it is very normal for waiting lists to exist.
Did You Know?
Free assistance is available to help Florida residents find assisted living within their means. Get help here.
Eligibility Guidelines
Eligibility for the ADA Waiver is determined on three levels: age, functional ability and financial resources.
Age and Functional Ability
Persons under 60 are not eligible regardless of their functional ability. Persons between the ages of 60-64 are eligible if they are considered disabled by Social Security. Persons aged 65 and older qualify if assistance is needed for four or more activities of daily living such as bathing, toileting or grooming. Individuals who do not require this level of assistance but are diagnosed with Alzheimer’s or other progressive conditions may also qualify.
Financial Restrictions
To qualify, applicants must meet the financial limits set for Florida Medicaid. Florida consider both the applicant’s (and their spouses, if married) incomes and assets. The monthly income limits this year (2014) for an individual and couple respectively are $2,163 and $4,326. If one spouse is applying for Medicaid and the other spouse is not, income can be shifted to the non-applicant to help the applicant qualify.
The assets limits for an individual and couple are $2,000 and $3,000 respectively. However, these numbers are somewhat misleading for several reasons. First, not every asset is considered a countable asset. For example, one’s home and primary vehicle are not counted provided they are being used and are not idle investments. Second, if one spouse is not seeking Medicaid, the asset limit rises dramatically to $117,240. Third, there are other techniques utilized by Medicaid planning professionals that help to convert assets from countable to exempt.
Benefits and Services
Waiver participants are provided with a case manager who helps to determine their needs and the services for which they are qualified. In addition to case management, this waiver can provide for any of the following:
- Attendant Care
- Behavior Management
- Chore Services
- Companion Services
- Medication Administration Assistance
- Durable Medical Equipment
- Disposable Medical Supplies
- Personal Care
- Medical Equipment
- Physical Therapy
- Social and Recreation Services
- Transition Assistance (from nursing homes)
How to Apply / Learn More
Unlike nursing home care, Medicaid funded, assisted living is not an entitlement and wait lists are the norm.
The Assisted Living Waiver is available statewide. However, interested applicants should be aware that unlike other institutional Medicaid programs, this is not an entitlement. One may meet all the eligibility requirements only to find that there are no available slots and they are put on a waiting list for services. In 2013, for every two persons receiving services, a third was on the waiting list.
This waiver is managed by the Florida Department of Elder Affairs. One should their local Area Agency on Aging to learn more and determine if a wait list exists in their geographic area.
I'm not a stranger to the intricate world of Medicaid Home and Community-Based Services (HCBS) Waivers, particularly in the context of long-term care for the elderly. My expertise in the field spans across various states, and today, I'll delve into the specifics of Florida's Assisted Living for the Elderly (ALE) Waiver.
Let's dissect the core elements of the information you provided. The ALE Waiver, initiated by Florida, is a strategic move to redirect elderly individuals from the more costly nursing home facilities to assisted living residences. This not only addresses the financial aspect but also caters to the individual's preference for a more home-like setting. The win-win situation is apparent—the state saves money, and the elderly receive care in a more desirable environment.
Eligibility is a crucial aspect, determined by age, functional ability, and financial resources. Those aged 65 and older qualify if they need assistance with four or more daily activities or have progressive conditions like Alzheimer's. Financially, there are income and asset limits, with nuances such as exempt assets and income shifting for married couples applying for Medicaid.
The program's capacity to serve approximately 5,000 persons highlights the demand, yet waiting lists persist—a common challenge in the realm of Medicaid-funded assisted living. The Florida Department of Elder Affairs manages this waiver, emphasizing the need for interested applicants to connect with their local Area Agency on Aging to navigate the intricate landscape.
Benefits and services under the ALE Waiver encompass a comprehensive range, from case management and attendant care to medication administration assistance and social and recreation services. The waiver serves as a lifeline for those transitioning from nursing homes.
Understanding the intricacies of applying for this waiver is vital. Unlike nursing home care, assisted living through Medicaid isn't an entitlement, leading to the prevalence of wait lists. This underlines the importance of proactive engagement with local agencies to navigate the eligibility requirements and potential waitlists effectively.
In the complex realm of Medicaid and long-term care, the ALE Waiver stands as a testament to Florida's commitment to optimizing resources, providing tailored care, and navigating the delicate balance between individual preferences and financial prudence.
