Florida Medicaid long-term care for dementia

How Florida Medicaid pays for long-term dementia care

Florida delivers most Medicaid long-term care through the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, often called the LTC waiver.

The Agency for Health Care Administration (AHCA) runs it, and services come through private managed care health plans. The program pays for long-term services and supports, either at home and in the community or in a facility. It does not replace regular health coverage: doctor visits and hospital stays are handled separately.

Two things surprise many families. First, the LTC program is not an entitlement: meeting the rules does not guarantee a spot right away, because space for home and community services is limited. Second, three different state agencies are involved, so the process has several steps.

Who is eligible

Your loved one generally needs to meet both medical and financial rules:

• Age or disability: 18 or older and in need of long-term services and supports.
• Medical need: needs a nursing facility level of care, as determined by the Department of Elder Affairs’ CARES assessment.
• Financial need: meets Medicaid income and asset rules, as determined by the Department of Children and Families (DCF).

2026 income and asset limits

DCF’s financial eligibility standards for April 2026 list these limits for institutional care, home and community-based services and hospice:

These standards change during the year, and how income and assets are counted is complicated. Income over the limit, a spouse who will stay at home, a home, or gifts made in recent years can all change the picture. This is the point where a Florida elder law attorney is worth consulting, before you move any money.

What the program can cover

AHCA lists these long-term care services. Your loved one’s case manager decides which services go into their plan of care based on assessed needs.

Hiring someone you know

Plans must offer a Participant Direction Option to eligible enrollees living in their own or a family home. Under it, your loved one (or a representative) can hire their own worker for adult companion care, homemaker services, personal care and certain nursing services. AHCA’s plan contract says enrollees may hire neighbors, family members or friends who meet the minimum qualifications, though a person acting as the enrollee’s representative cannot also be the paid worker.

How to apply for Florida Medicaid long-term care, step by step

1. Call your local Aging and Disability Resource Center (ADRC), or the Elder Helpline at 1-800-96-ELDER (1-800-963-5337), and ask for a long-term care screening. The screening is done by phone.

2. Get placed on the waitlist. Your screening results set a priority rank. People with a low priority rank may not be placed on the waitlist, so describe needs fully: wandering, falls, getting lost, unsafe cooking, caregiver exhaustion. If needs change while you wait, call the ADRC back and ask whether a new screening is appropriate.

3. Release and assessment. When a slot opens, the Department of Elder Affairs’ CARES program assesses your loved one, usually at home and at no cost, to confirm nursing facility level of care.

4. Apply with DCF for financial eligibility. DCF reviews income and assets and mails a decision.

5. Choose a plan. Once approved, AHCA sends a welcome packet explaining how to choose a long-term care health plan, which then assigns a case manager.

One exception to the waitlist: under AHCA’s plan contract, someone who has lived in a nursing facility for at least 60 consecutive days can transition to home and community services without being released from the waitlist.

Find your ADRC

Florida has 11 ADRCs, one per planning and service area. For the areas Dementia Companions serves:

Pinellas County is served by the Area Agency on Aging of Pasco-Pinellas, (727) 570-9696.

While you wait

Waits for home and community services can be long, and dementia does not pause. Many families pay privately for a few hours of help a week in the meantime, check state-funded programs such as the Alzheimer’s Disease Initiative and Community Care for the Elderly, and look at VA benefits if a veteran is involved. Keep notes on changes in your loved one’s condition so you can update the ADRC. Our paying for dementia care overview lists every option.

Dementia Companions is a private-pay service and does not bill Medicaid. This page is general information and not legal or benefits advice.