The one thing most families get wrong
Families often hear "Medicaid pays for assisted living" and picture the whole monthly bill covered. That is not how Florida's program works. Medicaid Long-Term Care pays for the care services a resident receives. The room and board — the bed, the meals, the roof — is paid by the resident and family. Once you understand that split, everything else about the process — including why a family supplement is normal, not a surprise — makes sense.
PART 1What SMMC Long-Term Care is — and what it covers
Florida delivers most Medicaid services through managed care. The Long-Term Care part of that system — SMMC LTC — is the program that can help pay for long-term services for people who need a nursing-home level of care but receive it in a less restrictive setting, such as their own home or a licensed assisted living facility. The Agency for Health Care Administration (AHCA) administers the program; private managed care plans (MCOs) contracted with the state coordinate and pay for the covered services.
What the plan pays for: the care
- Help with daily activities in the facility — bathing, dressing, grooming, eating, mobility
- Medication assistance and management
- Housekeeping and laundry connected to the resident's care
- Social and therapeutic activities provided as part of care
- Case management — a plan case manager who builds and reviews the care plan
- Other long-term care services the plan authorizes based on assessed need (the exact package is individual)
What the plan does NOT pay for: room & board
- The room itself — private or semi-private
- Meals and the cost of living in the home
- Utilities and the everyday costs of residence
Room and board is paid by the resident — typically from their own income, such as Social Security or a pension — with family help when income alone doesn't reach the home's price. That gap is the "family supplement" explained in Part 4.
Three state agencies, three different jobs
- AHCA administers Florida Medicaid and contracts with the managed care plans.
- Department of Elder Affairs (DOEA) — through its CARES unit and the local Aging and Disability Resource Centers (ADRCs) — handles screening, the wait list, and medical eligibility (level of care).
- Department of Children and Families (DCF) decides financial eligibility for Medicaid.
Knowing who does what saves weeks of calling the wrong office.
PART 2Who may qualify — in broad terms
Eligibility has several independent gates, and a person must pass all of them. In broad terms, an applicant generally must:
- Live in Florida and meet Medicaid's residency and status requirements.
- Be 65 or older, or 18 or older and eligible for Medicaid because of a disability.
- Need a nursing-facility level of care — real, ongoing help with daily activities, as determined by the state's CARES assessment (Part 3), not by the family or the facility.
- Meet Medicaid's financial limits on monthly income and on countable assets, as determined by DCF. There are also rules about transfers of assets in the years before applying, and protections that can apply to a spouse who remains at home.
About the exact numbers: the income cap, the asset limit, spousal allowances, and related figures are set by federal and state rules and are updated periodically — a number you read on any website (including this one) can be out of date by the time you apply. We deliberately do not build your plan around a figure printed here. Confirm the current limits with DCF, your ADRC, or a qualified professional before you move money, spend down assets, or assume you do — or don't — qualify. Some people who appear to be over a limit may still have lawful options; that analysis is exactly the part that requires individual professional advice, which this page is not.
PART 3The process, step by step — with honest timing
This is a state process with several offices involved. Families who start early and keep their paperwork organized move through it faster — but no honest person will promise you a date. The full path commonly takes weeks to many months, and time on the wait list is the part no one controls.
Screening through your local ADRC
Call your local Aging and Disability Resource Center — statewide, the Elder Helpline at 1-800-963-5337 (1-800-96-ELDER) connects you. The screening is a telephone conversation about care needs. The resulting score and priority ranking decide placement on the LTC wait list.
Wait-list release and Form 3008
When enrollment opens for your loved one, the ADRC contacts you and sends the Medical Certification form (Form 5000-3008). A Florida-licensed physician, APRN, or PA who knows the patient completes it, and it must be returned to the ADRC for the process to move forward.
Apply for Medicaid with DCF
If your loved one is not already on Medicaid, the ADRC will tell you an application is needed. Applications for financial eligibility are processed by the Department of Children and Families. Expect to document income, assets, and several years of financial history.
The CARES assessment
After the completed Form 3008 is returned, CARES staff visit in person to decide the level of care — whether your loved one meets the nursing-facility level of care the program requires. This is the state's medical decision, made by CARES, not by a facility or a plan.
Choose a managed care plan
AHCA sends a welcome packet explaining how to select a plan. You choose an LTC plan available in your region through Florida's Choice Counseling — online at flmedicaidmanagedcare.com or at 1-877-711-3662. Plans that serve Florida LTC members include Simply Healthcare, Florida Community Care, and Humana, among others; availability is by region, so confirm the current list for Brevard County when you enroll. If you don't choose within the window, the state can assign a plan — choosing yourself is better, because the facility your loved one wants must be in that plan's network.
Case manager, care plan, and authorization
The plan assigns a case manager, who assesses needs and builds the care plan. Before a Medicaid resident moves into an assisted living facility, the plan must authorize the services there. No authorization, no plan payment — which is why the facility, the family, and the case manager coordinate before a move-in date is set.
Admission — with the supplement agreed first
The resident moves in once eligibility, plan enrollment, and authorization are in place — and, at Bella Vita, once the family supplement that completes the home's price is agreed in writing (Part 4 and Part 5). The facility also completes its own normal admission requirements, including Florida's 1823 health assessment.
PART 4The honest math: plan payment + family supplement
Put simply: the plan pays the facility for the care services it authorizes, and the resident/family pays the rest of the home's monthly price — starting with room and board. The plan's monthly amount is set by the plan's contract and the resident's assessed needs; it is not the home's full price, and it is not negotiated at the kitchen table. The family's share is agreed with the home before move-in, so there are no surprises later.
How the two parts can add up — a round-number illustration
| Hypothetical home's total monthly price (generic example figure) | $5,000 |
| Paid by the LTC plan for authorized care services (illustrative, ≈) | − $1,800 |
| Paid by the resident / family (the supplement: room, board & the remaining share) | $3,200 |
The arithmetic: $1,800 + $3,200 = $5,000. Every figure in this box is a generic round number chosen only to show how the split works. It is not Bella Vita's price, not any plan's promised rate, and not any family's actual supplement — those are set by the plan, the assessed level of care, and a free care evaluation at the home. The supplement is commonly covered from the resident's own monthly income first, with family contributing the difference.
What this means in practice
- Medicaid LTC reduces what a family pays out of pocket — it does not usually reduce it to zero.
- A family that plans only for "Medicaid will cover it" and budgets nothing for the supplement is planning to be surprised.
- The supplement amount belongs in writing, agreed before move-in — at Bella Vita, that is a condition of a Medicaid admission, stated up front in Part 5.
PART 5What this means at Bella Vita
- Bella Vita accepts Medicaid Long-Term Care with Simply Healthcare beginning December 1, 2026. Medicaid admissions at Bella Vita are through the Simply Healthcare LTC plan. If your loved one's plan is a different one, ask us — and ask Choice Counseling — what changing plans would involve; do not assume coverage transfers automatically.
- The Medicaid-available bed is the semi-private bed (male) shown in the availability banner above. The private room is a private-pay opening.
- Every Medicaid admission must complete the home's price with the agreed family supplement, arranged before move-in. The plan pays its authorized share for care; the resident/family pays the rest, starting with room and board. We put the full arrangement in writing before anyone moves — clearly, and with no surprises afterward.
- We cannot approve Medicaid, speed up the wait list, or promise an outcome. What we can do: answer the phone ourselves, do the free care evaluation the same day, tell you plainly whether the available bed fits your loved one, and coordinate with the plan's case manager once authorization is in motion.
- Start the state process early — even before you choose a home. The screening call to the ADRC costs nothing and starts the clock. Families who begin while they are still comparing homes are the ones ready when a bed and an authorization line up.
Alejandro Cardozo — Owner and Administrator
Bella Vita is a six-resident home in Palm Bay where one caregiver can truly know every resident — their medications, their routines, how they take their coffee. I handle admissions and families myself: when you call, I answer, and care evaluations happen the same day. Every Friday, families receive a written report on their loved one's week — appetite, medications, activities, and anything that changed.
Bella Vita Assisted Living Facility · 1405 Graves St SE, Palm Bay, FL 32909 · AHCA License #14019 · (407) 914-5350
Official sources — verify everything here
This guide was written from Florida's own program pages. Rules change; these are the channels that decide:
- AHCA — SMMC Long-Term Care Recipient FAQs: ahca.myflorida.com — LTC Recipient FAQs
- AHCA — Become Eligible for Medicaid (the screening, Form 3008, DCF, and CARES steps): ahca.myflorida.com — Become Eligible for Medicaid
- Florida Department of Elder Affairs — SMMC Long-Term Care Program (services and eligibility basics): elderaffairs.org — SMMC LTC Program
- Florida Medicaid Choice Counseling — enroll in or change an LTC plan (1-877-711-3662): flmedicaidmanagedcare.com — Enroll
- Elder Helpline / ADRC screening: 1-800-963-5337 (1-800-96-ELDER). DCF decides financial eligibility; CARES (DOEA) decides medical eligibility. Verify any home's license on floridahealthfinder.gov — Bella Vita is AHCA License #14019.
The printable Florida Medicaid LTC Guide — free
The same walk-through on paper: what Medicaid covers and what it doesn't, the steps in order, the documents to gather, and the plan + supplement math explained with a clearly labeled example. Print it, bring it to family meetings, and check the boxes as you go. Tell us where to text it — we'll send a quick code to confirm your number, then the guide is yours.