The need for assisted living for most people, is not something which individuals plan for. Finding a facility is a difficult process – luckily there is help available to make the process as smooth as possible. Unfortunately, one option is being denied to Medicaid recipients by the state of Florida. For the purposes of this article let’s use ‘Mary ‘ as an example.

Mary has been living in her own apartment surviving on a low income and receiving Medicaid. Mary’s health has been declining over the past couple of months and she has been finding it increasingly difficult to do things on her own. One day, Mary fell in her apartment and found herself in the hospital. Mary suffered moderate injuries and voiced her concerns to the social worker – that she has no family and is afraid to go back home by herself. Mary is concerned that she cannot care for herself, as she could before.

The social worker suggests that the best option would be for Mary to go into an assisted living facility. Mary agrees, and the social worker arranges for an assisted living placement specialist to come and talk to Mary about her ALF options.

The placement specialist has toured numerous facilities and knows which facilities Mary will do best in. The specialist will also have the facilities to send someone out to speak with Mary to help her make the best choice.

The social worker’s position is very demanding. She has many patients to care for and the task of finding the right facility is a process that takes hours – researching facilities, calling facilities, explaining the patient’s situation, arranging for the facilities to come out and evaluate the patient and meeting with the facilities can be a time-consuming process. The social worker can eliminate most of these steps by making one phone call instead of multiple calls. Even if the social worker went through these exhaustive steps, she has never toured the facilities and would be relying on a list of paid advertisements in order to make her recommendations.

The social worker contacts the placement agency, however, the placement agency learns that Mary is on Medicaid and informs the social worker that they cannot take on this case due to a regulation prohibiting assisted living facilities from using placement services for residents on Medicaid.

The social worker informs Mary of the bad news – that the placement specialist will not be coming out to discuss ALF options with her because she has Medicaid.

Mary is devastated and starts to worry about how next to proceed. The social worker tells her that she has called five facilities already but unfortunately, her income is too low. The DR comes to see Mary and writes a discharge order. Mary is now ready for discharge but has no place to go. Mary is also now occupying a bed that the hospital will not get paid for, further increasing the pressure to find Mary an ALF placement.

After numerous phone calls and hours working to find Mary a placement, the social worker finally finds a facility willing to take Mary. The facility accepts Mary over the phone without coming out and talking with Mary to answer any questions she might have.

Mary is informed that a facility has been found and she will be transferred in the next few hours. Instead of being happy, Mary is scared and asks, “Where is it located?” The social worker tells her the location. Mary says “Oh my! That’s so far”. Mary then asks questions such as, “Do you know anything about this facility”? “Is it a nice place?” “Have you ever been there?”

The social worker tells Mary that she hasn’t been there herself, but assures her it’s nice. Mary, understandably, is anxious and scared. During her adult life, she has always made smart, conscientious decisions. Mary is frustrated that she was denied the opportunity to access better options by the state of Florida. She feels she has been forced into a bad situation, that could have been avoided.

Mary arrives at her new assisted living facility unaware that the facility is one of the worst ALF’s in the area.  There were many better options available for Mary. Unfortunately, she may never know.

Here is the regulation that is denying Medicaid recipients like Mary the service of being able to get better informed assisted living options. Since the criteria to be on the Medicaid program is having a low income it is disturbing that the state would discriminate and deny these services to this vulnerable population.

The Regulation

ST – A0006 – Licensure – Rebates Prohibited; Penalties

(b) Payments by an assisted living facility to a referral service that provides information, consultation, or referrals to consumers to assist them in finding appropriate care or housing options for seniors or disabled adults if the referred consumers are not Medicaid recipients.

As Florida’s elderly population continues to grow it is time for the state to review this regulation and make a change as they are hurting the state’s Medicaid recipients by forcing them into unnecessary bad situations.