Statewide Medicaid Managed Care Long-Term Care Program - Screening

The first step in getting services through the Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) program is getting screened by an Aging and Disability Resource Center (ADRC).  A list of the ADRCs is on the Florida Department of Elder Affairs (DOEA) website or persons may call the statewide toll-free Elder Helpline at 1-800-96-ELDER (1-800-963-5337).  The screening is done over the phone with the person and/or caregiver and takes about 45 minutes to an hour to finish.  The screening yields a priority score and rank used for placement on the wait list to receive long-term care services.

When the screening process is finished, DOEA will notify in writing the person, or his or her authorized representative*, of their priority rank, contact information for the ADRCs, and instructions for requesting the following:

• An administrative fair hearing;
• A copy of the completed screening tool, which includes the priority score; and
• A rescreening due to a significant change.

Individuals with a Low Priority Rank will not be placed on the wait list, and provided with information on how to find community resources available to assist them. Individuals with a High Priority Rank will be notified of wait list placement.

*Authorized Representative is defined in 409.962 Florida Statutes and means an individual who has the legal authority to make decisions on behalf of a Medicaid recipient or potential Medicaid recipient in matters related to the managed care plan or the screening or eligibility process.

Individuals with a Low Priority Rank, or their authorized representative,* may contact the Aging and Disability Resource Center (ADRC) to ask for screening to be done again. The ADRC may rescreen these individuals annually upon request or upon notification of a significant change as defined in section 409.962(17), Florida Statutes.  A significant change is when any of the following happens:

• A change in a person’s health status after an accident or illness;
• An actual or expected change in an individual’s living situation;
• A change in the caregiver relationship;
• Loss or damage to the person’s home or decline of his or her home environment; or
• Loss of the person’s spouse or caregiver.

*Authorized Representative is defined in 409.962 Florida Statutes and means an individual who has the legal authority to make decisions on behalf of a Medicaid recipient or potential Medicaid recipient in matters related to the managed care plan or the screening or eligibility process.

Current Florida Medicaid recipients who meet certain requirements are afforded priority for home and community-based services through the Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) program and do not have to complete the screening or wait list process if all other LTC managed care program eligibility requirements are met; these recipients include:

• An individual who is 18, 19, or 20 years of age who has a chronic debilitating disease or condition of one or more physiological or organ systems which generally make the individual dependent upon 24-hour-per-day medical, nursing, or health supervision or intervention.
• A nursing facility resident who requests to transition into the community and who has resided in a Florida-licensed skilled nursing facility for at least 60 consecutive days.
• An individual who is referred by the Department of Children and Families pursuant to the Adult Protective Services Act, ss. 415.101-415.113, as high risk and who is placed in an assisted living facility temporarily funded by the Department of Children and Families.
• An adult with Cystic Fibrosis; persons, their caregivers, or providers should contact DOEA for more information by Email: MedWaiver@ElderAffairs.org
  Phone: (866) 232-3733, or Fax: (850) 354-5095.  Individuals and their caregivers can also contact their local Aging and Disability Resource Center (ADRC) for referral.