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


Florida has twelve home and community-based waiver programs, including several that serve substantial numbers of elderly persons or only elderly persons.3 The two major waiver programs that serve older persons are:

  • The Aged/Disabled Adult (ADA) waiver, which was implemented statewide on April 1, 1982. Generally, it does not serve people in residential care settings, only eligible individuals in their own homes.

  • The Assisted Living for the Elderly (ALE) Waiver serves recipients who reside in qualified Assisted Living Facilities (ALFs). The waiver program was implemented in 1995 as a small pilot and was expanded to statewide waiver status in 1997.

When the ALE waiver was initiated in 1995, the State planned to serve 220 individuals with a $2.3 million appropriation, averaging $10,454 per person a year. In 2001, the state served 3,179 ALE recipients receiving an average annual ALE reimbursement of $9,937.

3. Two additional waiver programs that serve elderly persons are:

  • The Consumer-Directed Care Research and Demonstration Waiver is an 1115 waiver program, which is available in certain counties for individuals receiving services through the Aged/Disabled Adult and other waivers. Individuals chosen to participate in the experimental group are allowed to "cash out" services on their current care plans and receive a monthly benefit through a fiscal intermediary to purchase services directly from a provider of their choice. The program was implemented in 2000. There was difficulty in getting CMS to approve operational protocols related to coverage of services in assisted living facilities.

  • The Medicaid Nursing Home Diversion (NHD) Waiver provides services to 868 functionally impaired elderly persons age 65 and over who are at risk of nursing home placement in Palm Beach and the Orlando area. Dual eligible (Medicare and Medicaid) individuals that meet clinical eligibility criteria may choose to receive both long-term care and acute care services under the NHD Waiver. Managed care providers that have contracted with the state under the NHD Waiver are responsible for Medicare co-payments and deductibles. Providers are reimbursed at a capitated rate, on a per member, per month basis to enrolled Medicaid providers.

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