Dad Wants to Stay in His House: Can Florida Medicaid Pay for Care at Home?

Meet Art: A Korean War Veteran Who Isn't Leaving His House

Art is 89, lives in Holly Hill, and built the house he still calls home with his own hands after coming back from Korea. His daughter drives over every day to help him bathe, manage his medications, and get a hot meal on the table. She estimates she's putting in about four hours a day, on top of her own job and family. She has heard the words "nursing home" and watched her father's face fall every time. Art is a composite example, not an actual Truestead client, but his situation is one I hear described almost word for word in my office most weeks.

The good news for families like Art's is that Florida Medicaid does not force a choice between "pay privately for someone in the home" and "move to a facility." There is a real, funded path called the Long-Term Care (LTC) waiver, part of Florida's Statewide Medicaid Managed Care program, built specifically to pay for services that let someone who needs nursing-facility-level care stay in the community instead. I won't repeat our general eligibility guide here (income, assets, and the five-year lookback are covered in other articles), but I do want to walk through exactly what happens for someone like Art from the first phone call to services showing up at his door.

Step One: The ADRC Screening Call

Everything starts with a call to Florida's Aging and Disability Resource Center (ADRC), reachable through the statewide Elder Helpline. A family member can make this call on the person's behalf, which is exactly what Art's daughter did.

The screening itself is done by phone with the applicant and/or caregiver and typically takes 45 minutes to an hour. The ADRC specialist asks about the person's medical conditions, ability to perform daily activities like bathing, dressing, and toileting, cognitive status, current living arrangement, and the caregiver support already in place. For Art, that meant describing his mobility limitations, his daughter's four hours of daily help, and the fact that without her, he could not safely stay in his house alone.

This single call generates two things: a record in the system, and the raw information used to calculate what comes next.

Step Two: The Priority Score and the Waitlist

The information from the ADRC screening feeds into a priority score, calculated under a methodology set out in Florida Statutes, section 409.979, and administered by the Department of Elder Affairs. The score is meant to rank need, not need alone but urgency: someone with a fragile or absent caregiver, significant functional decline, or an unstable living situation typically scores higher than someone with stronger informal support already in place.

Here is the part families need to hear clearly: the Long-Term Care waiver is not an entitlement the way institutional nursing home Medicaid is. There is a statewide waitlist, and a higher priority score moves someone up the list, but it does not guarantee a specific wait time. Release from the waitlist happens when the state has an opening to enroll someone, and it is based on priority rank and available slots, not simply on how long a name has been sitting there.

Step Three: Enrollment in a Managed Care Plan

When an opening becomes available, the ADRC contacts the person (or family) and enrollment begins. Under Florida's Statewide Medicaid Managed Care structure, the LTC waiver is administered through managed care plans, not a single state office writing checks. Once financial Medicaid eligibility is confirmed through the ACCESS Florida system, the applicant selects (or is assigned) a managed care plan, and that plan takes over authorizing and coordinating the actual services.

This is also the point where a case manager gets assigned. For a family like Art's, the case manager becomes the point person: the one who helps build a plan of care, decides how many hours of personal care make sense, and adjusts services as needs change over time.

Step Four: What Services Actually Show Up At Home

Once enrolled, the LTC waiver can cover a genuinely wide range of home and community-based services, including:

• Personal care and homemaker help with bathing, dressing, meals, and light housekeeping
• Attendant care and skilled or intermittent nursing
• Adult day health care and adult companion services
• Respite care to give family caregivers a break
• Home delivered meals
• Personal emergency response systems (medical alert devices)
• Home accessibility adaptations, such as ramps or grab bars
• Physical, occupational, speech, and respiratory therapy
• Medical equipment, supplies, and medication management
• Case management and caregiver training

For Art, the realistic scenario is a combination of personal care and homemaker hours to fill the gaps his daughter can't always cover, a personal emergency response system for the hours he is alone, and possibly home accessibility work so a walker or wheelchair can move safely through the house he built decades ago.

The Participant-Directed Option: Can Art's Daughter Get Paid?

Many families ask whether a daughter or son who is already providing care can be paid through Medicaid instead of a stranger showing up at the door. Florida's answer is the Participant-Directed Option (PDO). Under PDO, the enrollee (or a representative) essentially becomes the employer, choosing and directing their own workers rather than accepting only agency-assigned staff.

Florida does not require a special license or certification to provide personal care, homemaker, or adult companion services under this option, though attendant care does require licensure. Family members, including legally responsible individuals in some circumstances, can be hired as paid caregivers as long as they meet the plan's qualifications, sign a PDO work agreement, and pass required background checks. The managed care plan sets the pay rate and handles payment, not the family directly.

For a family like Art's, this can mean his daughter's daily four hours of hands-on help is no longer entirely unpaid and invisible. It also means the plan of care can be built around the caregiving relationship that already exists, rather than replacing it with an unfamiliar aide.

Combining Medicaid Waiver Services With VA Benefits

Because Art is a veteran, his family should also look at whether VA benefits, such as Aid and Attendance, can run alongside the Medicaid waiver. In many cases these programs can work in a coordinated way, with VA benefits covering costs the Medicaid waiver does not, or filling gaps while someone waits for a waiver opening. The specifics depend on the veteran's service history, discharge status, and current VA enrollment, so this is an area where I always recommend a conversation with both a VA-accredited representative and an elder law attorney familiar with how the two systems interact in Florida.

Sources

• Florida Agency for Health Care Administration (AHCA), "Statewide Medicaid Managed Care Long-Term Care Program - Screening"
• Florida Agency for Health Care Administration (AHCA), "SMMC LTC Program Waitlist Release"
• Centers for Medicare & Medicaid Services (CMS), "FL Long-Term Care Waiver (0962.R02.00)" Federal Authorities Factsheet
• Elder Needs Law, "Medicaid Waiver Waitlist and Priority Scores," May 9, 2026
• Medicaid Planning Assistance, "Florida Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) Program," June 5, 2026
• National Academy for State Health Policy (NASHP), "Paying Family Caregivers through Medicaid Consumer-Directed Programs," April 28, 2025

This article is for general informational purposes only and does not constitute legal advice, nor does reading it create an attorney-client relationship. Florida estate, elder, probate, and real estate law are fact-specific and change over time. Consult a licensed Florida attorney about your individual circumstances. Arthur Simpson, Esq. is licensed to practice law in the State of Florida. Attorney advertising.