SSI-Related Medicaid Fact Sheet 6
COVERAGE GROUPS WITH FULL BENEFITS
Medicaid for Aged and Disabled (MEDS-AD)
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Medicaid for low-income individuals who are either aged (65 or older) or disabled.
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This coverage group does not include blind individuals unless they are disabled.
Institutional Care Program (ICP)
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The Institutional Care Program (ICP) helps individuals in nursing facilities pay for
the cost of their care and other medical services.
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Additional technical criteria include:
o
An evaluation to need nursing facility services and appropriate placement
as determined by the Department of Elder Affairs (DOEA),
Comprehensive Assessment and Review for Long-Term Care Services
(CARES) process to determine the level of care (LOC).
o
Other important criteria for ICP eligibility include:
Transfer of Assets – assets transferred on or after January 1, 2010,
may potentially affect eligibility. The “look-back” period for asset
transfers is 60 months prior to the application month.
Spousal Allowance – assets and income are evaluated for married
individuals when one spouse is institutionalized, and one spouse
continues to reside in the community (referred to as the “community
spouse”). The community spouse (CS) may be eligible to receive a
portion of the institutionalized spouse’s income.
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Additional information on forms and instructions is located on AHCA’s website for
Medicaid Nursing Facility Provider Information.
Hospice
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Hospice services help maintain care for terminally ill individuals. T o
receive Hospice care, the individual must enroll in Hospice.
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Additional technical criteria include:
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A medical prognosis that life expectancy is six months or less,
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Election of hospice services, and
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A certification of the individual’s terminal illness by a physician or medical
director.
Program of All-Inclusive Care for the Elderly (PACE)
• PACE provides home and community-based services for individuals in need of
nursing facility care as assessed by DOEA CARES. Once enrolled in PACE, an
individual may continue services even if the individual is admitted to an assisted
living facility (ALF) or nursing home. More information can be found at:
http://www.ahca.myflorida.com/
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Additional technical criteria include:
o
election of a PACE provider as the sole source of Medicare and/or
Medicaid service delivery,
o
at least age 55 or older (must meet disability criteria if under age 65), and
o
meet a nursing home LOC as determined by CARES.
Note: PACE is not a waiver but individuals who are potentially eligible under this coverage
group may apply directly with DCF. When applying, the applicant should select “Medical
Assistance for Individuals Seeking Medicaid Waiver Services
”.