The Florida Statewide Medicaid Managed Care (SMMC) program was established in 2011 by the Florida Legislature to transform how certain individuals receive long-term care and healthcare services through Florida Medicaid. This initiative led the Agency for Health Care Administration (AHCA) and the Department of Elder Affairs to restructure the delivery of long-term care services for eligible Floridians.
The SMMC program is comprised of two distinct yet integrated programs:
- The Long-Term Care (LTC) Managed Care Program
- The Managed Medical Assistance (MMA) Program
Medicaid beneficiaries who meet specific criteria and enroll in the SMMC LTC program gain access to essential long-term care services through a network of managed care plans. This structured approach ensures that individuals receive coordinated and comprehensive care tailored to their needs.
Services Provided Under the SMMC Long-Term Care Program
Each managed care plan within the SMMC LTC network is contracted with AHCA to deliver a comprehensive suite of long-term care services. These services are designed to support individuals in various aspects of their daily living and healthcare needs, and at a minimum, include:
- Adult Companion Services
- Adult Day Care (Adult Day Health Care)
- Assistive Care Services
- Assisted Living Facility Services
- Attendant Care
- Behavior Management
- Caregiver Training
- Case Management
- Home Accessibility Adaptation
- Home Delivered Meals
- Homemaker Services
- Hospice Care
- Intermittent and Skilled Nursing Care
- Medical Equipment & Supplies
- Medication Administration
- Medication Management
- Nursing Facility Care
- Nutritional Assessment and Risk Reduction
- Occupational Therapy
- Personal Care
- Personal Emergency Response System
- Physical Therapy
- Respiratory Therapy
- Respite Care
- Speech Therapy
- Transportation Services
Florida Medicaid logo representing the Statewide Medicaid Managed Care program, offering long-term care services for eligible residents.
The availability of these services is determined by medical necessity, or when these services are deemed necessary to prevent or delay the need for nursing facility placement. This ensures that individuals receive the appropriate level of care in the most suitable setting.
Eligibility Criteria for SMMC Long-Term Care
To be eligible for services under the SMMC LTC program, individuals must meet specific criteria:
- Age and Medicaid Eligibility:
- Be 65 years of age or older and eligible for Florida Medicaid.
- Be 18 years of age or older and eligible for Florida Medicaid due to a disability.
- Nursing Home Level of Care Determination:
- Be assessed by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit of the Department of Elder Affairs and determined to require a nursing home level of care.
- Meet one or more established clinical criteria as determined by CARES.
For detailed information regarding the Statewide Medicaid Managed Care Long-Term Care program, please visit the official LTC website provided by AHCA: http://ahca.myflorida.com/Medicaid/statewide_mc/smmc_ltc.shtml
The Role of the Independent Consumer Support Program (ICSP)
The Independent Consumer Support Program (ICSP) is a collaborative initiative designed to assist individuals enrolled in the SMMC LTC program. It is a coordinated effort by:
- The Florida Department of Elder Affairs’ Bureau of Long-Term Care & Support (LTCS)
- The statewide Long-Term Care Ombudsman Program (LTCOP)
- Local Aging and Disability Resource Centers (ADRCs)
- AHCA
Florida’s ICSP ensures that SMMC LTC consumers have multiple avenues for support, offering “no wrong door” access to address information needs, complaints, grievances, appeals, or general questions. This multi-pronged approach leverages the expertise of each participating entity to efficiently resolve consumer issues.
Further Resources and Information on SMMC LTC
For additional details on the SMMC LTC program, including program overviews and summaries, please consult AHCA’s official website: http://ahca.myflorida.com/Medicaid/statewide_mc/smmc_ltc.shtml.
To explore the LTC plans available in each region and to receive guidance on choosing a plan that best suits individual needs, visit the Choice Counseling website: www.flmedicaidmanagedcare.com.
For inquiries about the SMMC LTC waitlist, individuals are encouraged to contact their local Aging and Disability Resource Center. Direct contact information for ADRCs in each region can be found through the provided link. Immediate assistance is also available by calling the statewide Elder Helpline at 1-800-96-ELDER.
For assistance with lodging a complaint regarding an LTC plan, please visit AHCA’s website at http://ahca.myflorida.com/SMMC and click on the “Report a Complaint” button. These resources are in place to ensure that individuals have access to the support and information they need to navigate the Florida Statewide Medicaid Managed Care Long-Term Care program effectively.
