What Is Florida Statewide Medicaid Managed Care?

What Is Florida Statewide Medicaid Managed Care?

Most Florida Medicaid recipients are enrolled in the Statewide Medicaid Managed Care (SMMC) Program. The Agency For Health Care Administration is responsible for administering the SMMC program and re-procuring health plans every five years. The SMMC program has two components, the Long-term Care (LTC) program and the Managed Medical Assistance (MMA) program.

 

Medicaid recipients who qualify and become enrolled in the Statewide Medicaid Managed Care – Long-term Care program will receive long-term care services from a long-term care managed care plan. Medicaid recipients who qualify and become enrolled in the Statewide Medicaid Managed Care – Managed Medical Assistance program will receive all health care services other than long-term care from a managed care plan.

 

Medicaid recipients will receive their long-term care services from a managed care plan. These managed care plans will cover long-term care services only and do not cover medications, doctor’s visits or other healthcare related services.

 

All long-term care managed care plans offer the following services:

 

  • Adult companion care
  • Adult day health care
  • Assisted care services
  • Assisted living
  • Attendant care
  • Behavior management
  • Care coordination/Case management
  • Caregiver training
  • Home accessibility adaptation
  • Home-delivered meals
  • Homemaker
  • Hospice
  • Intermittent and skilled nursing
  • Medical equipment and supplies
  • Medication administration
  • Medication management
  • Nursing facility
  • Nutritional assessment/Risk reduction
  • Personal care
  • Personal emergency response system (PERS)
  • Respite care
  • Therapies (occupational, physical, respiratory, and speech)
  • Transportation, non-emergency

 

All of these services are available based on medical necessity, or they must be necessary in order to delay or prevent nursing facility placement.

 

Individuals that meet the following criteria are eligible to receive services under SMMC LTC:

  • Age 65 and over and eligible for Medicaid
  • Age 18 and over and eligible for Medicaid by reason of a disability
  • Be determined by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit at the Department of Elder Affairs to be at nursing home level of care and meet one or more established clinical criteria.
By | 2018-06-27T02:35:04+00:00 April 5th, 2018|

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