Florida uses both the personal care option and the waiver program to cover services in residential care settings. Since 1975, Florida licensed a type of residential care setting called Adult Congregate Living Facility (ACLF), which provided room and board, assistance with one Activity of Daily Living (ADL), social services, and supervision of self-administered medication.14 ACLFs served a predominantly private pay clientele, but also some individuals who received SSI and an SSI supplement through the state's Optional State Supplementation program. The state did not have a residential care setting that was licensed to serve state supplement recipients who needed substantial levels of personal or home health care but not the level of skilled nursing care provided in nursing homes. Consequently, individuals with this level of impairment had to either enter a nursing home, at a much greater expense to the state, or find an unlicensed facility that would accept them.
To address this gap, in 1992 the state developed a new licensing category of ACLF called Extended Congregate Care that could serve residents with higher levels of need. However, at that time, Florida's waiver program served only individuals who lived in their own homes. In 1995,Florida initiated a pilot program called the Assisted Living for the Elderly waiver, which was designed to serve only individuals who reside in assisted living facilities. In 1997, the state expanded the waiver to statewide status.
In 2001, Florida amended its state plan to include personal care services, which are provided through a program called Assistive Care Services. Elderly persons who live in their own homes are not eligible to receive these services; only those who live in licensed adult family care homes and licensed assisted living facilities are eligible.15
Prior to the addition of personal care services to the state's Medicaid plan, Florida paid for some personal care in residential care settings through its Optional State Supplementation (OSS) program, which is funded by general revenues. The state supplement is not provided to individuals who live in their own homes. Once personal care was added to the Medicaid program, the state reduced the OSS payment and used the money saved to provide the state match for Medicaid personal care services.