Long Term Care

Did You Know? Assisted Living Facilities in Florida, have approximately 96,142 beds licensed with AHCA, which are home to thousands of our older and aging adults. Data shows most of these residents live in the assisted living setting for several years, spending their personal assets and monthly income to cover costs for living and care services. Some of these individuals do outlive/outlast their savings, or who have depleted savings beyond their monthly Social Security income, will face an unnecessary nursing home admission with a minimum stay of 90 days or even remain their long term as a custodial resident.

Why? LTC Statewide Medicaid Managed Care applicants who live in an assisted living setting are not ‘scored’as they are not recognized as needing or meeting the level of care (these are persons who do require assistance congruent with a level of care equivalent to that of the ICP guidelines). This is a barrier to accessing the program for many in this HCBS (Home and Community-Based Setting).

What happens? This “barrier” causes many of our aging and disabled to be displaced from their homes, unable to cover reasonable costs for living and the continued assistance, they require. This may lead to a 45-days notice of discharge from the assisted living and leaves them at risk for institutionalization. Once they are admitted to the nursing home they will become Medicaid pending, under (ICP) Institutional Care Program.

Why is this a problem? This barrier to access is driving increased utilization of costly nursing home stays to facilitate the application and approval process to onboard an otherwise eligible individual onto the LTC SMMC program. This is commonly referred to as a nursing home transition’ or ‘flip’, requiring an approximate 90-day nursing home stay for application, approval, plan selection and case management visit. Some may utilize skilled Medicare days as a gateway but ultimately this costs thousands of Medicaid-funded dollars. 

What does this cost? There are both economic and emotional costs with an estimated $10,000 – $15,000 per person, billed to Medicaid. This is an unnecessary expense and process to onboard someone who meets both the financial and medical mean for acceptance to the program regardless of where they are living. In most cases, these people are still able and willing to pay costs for room and board to assisted living and or are safe and appropriate to remain in their home. 

The ALF– assisted living rate of payment amount from the Managed Care Plans is a portioned payment, covering only ADL’s activities of daily living, and is a third of the cost in comparison to the monthly Medicaid rate paid to the nursing home for this custodial resident.

The state must review the language and ranking system for the Waitlist!