Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Family Supplementation

12/01/2003

For individuals receiving Optional State Supplementation (OSS), Florida allows third party supplementation for room and board and services not covered by Medicaid.7 Supplementation can be made by family or friends to cover the costs of room and board that the low OSS payment does not cover (e.g., for a private room) under the following conditions:

  1. Payments shall be made to the assisted living facility, or to the operator of an adult family-care home, family placement, or other special living arrangement, on behalf of the person and not directly to the optional state supplementation recipient.

  2. Contributions made by third parties shall be entirely voluntary and shall not be a condition of providing proper care to the client.

  3. The additional supplementation shall not exceed two times the provider rate recognized under the optional state supplementation program.

  4. Rent vouchers issued pursuant to a federal, state, or local housing program may be issued directly to a recipient of optional state supplementation.

When contributions are made in accordance with the statutory provisions listed above, the state does not count them as income to the client for purposes of determining eligibility for Medicaid or for OSS benefits. However, the SSI program does consider in-kind supplementation to be income to the client and reduces the SSI benefit by one third. Florida does not increase the OSS payment to offset the reduction in SSI benefits that occur due to third-party contributions. Thus, in addition to the original contribution, the third party has to pay the facility the amount that is reduced as well as its initial contribution.


7. Florida Statutes, Title XXX, Chapter 409.212.

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