Florida Medicaid Waiver Programs

Medicaid is a public benefits program jointly funded by the federal government and each of the states that provides medical services for individuals experiencing poverty and disabilities. Like each state, Florida manages its own program. However, oftentimes disabilities and illnesses are so unique or severe that an individual may require in-patient treatment or have to travel to find services. Florida's Medicaid waiver programs help recipients with certain medical conditions to receive services in their homes or communities that may not otherwise be available. The waiver services go above and beyond what is normally funded by Florida's Medicaid program.

Eligibility

• Medcaid eligibility in Florida is determined by either the Social Security Administration or the Florida Department of Children and Families. Eligibility for children, non-citizens and pregnant women is handled by the Department of Children and Families, while eligibility based on age or disability is determined by the Social Security Administration. For children to be eligible, families must not exceed maximum income limits or have countable assets of more than $2,000. The income limit varies depending on family size. Non-citizens are only eligible for emergency medical situations. Pregnant women may be eligible for assistance for prenatal care only or ongoing medical care, and pregnant women whose family income exceeds the financial limits may qualify for the Medically Needy Program. Individuals who qualify for Supplemental Social Security income because of age or disability are automatically eligible for Medicaid.

HCBS/DD waiver program

• The Home and Community Based Services for the Developmentally Disabled (HCBS/DD) waiver program is available only for people with disabilities. Waivers pay for items not normally covered by Medicaid that are medically necessary. Demand for the program is high, and there is a waiting list for those who qualify. There is no spending cap for the HCBS/DD waiver. There are several waivers available under the program, including waivers for adult cystic fibrosis, aged/disabled adult services, adult day health care, assisted living for the elderly, Alzheimer's disease, channeling services for the adult frail elderly, Consumer Directed Care Plus, developmental disabilities, familial dysautonomia, model, nursing home diversion, Project AIDS Care and traumatic brain Injury and spinal cord injury.

FSL waiver program

• The Florida Supported Living (FSL) waiver program is an alternative to the HCBS/DD waiver program for individuals with developmental disabilities. People waiting for an HCBS/DD waiver usually receive an FSL waiver. The goal is to provide services that enable persons with developmental disabilities to live in their own homes, rather than nursing facilities, as well as learn to function independently in the community. The FSL waiver has a spending cap of $14,792, whereas HCBS/DD does not have a spending cap. FSL only covers 11 services that must be medically necessary, including adult day training, behavior analysis and assistance, medical supplies, environmental accessibility adaptations, in-home support services, respite care, supported employment, transportation and a living coach.