Recipients of Assistive Care Services
Recipients of Assistive Care Services
Who is eligible for Medicaid Assistive Care Services?
A recipient of Assistive Care Services must be:
- A resident of a Medicaid-enrolled assisted living facility (ALF), adult family care home (AFCH), or residential treatment facility (RTF);
- Medicaid-eligible; and
- Assessed by a Physician, Physician Assistant, Advanced Registered Nurse Practitioner or Registered Nurse as needing at least two of the four assistive care service components.
What are the criteria for Medicaid eligibility?
To learn more about Medicaid or to apply for Medicaid, an individual should contact the local Department of Children and Families’ toll-free telephone number 1-866-762-2237 or by email at: http://www.dcf.state.fl.us/ess/. More information about eligibility can also be found on the Agency for Health Care Administration web site.
What is Optional State Supplementation?
Optional State Supplementation (OSS) is a cash assistance program administered by the Department of Children and Families. Its purpose is to supplement a person's income to help pay for room and board costs in an assisted living facility, mental health residential treatment facility or adult family care home. OSS is not a Medicaid program. This program was re-designed to provide the state funds for the federal Medicaid match to create Assistive Care Services.
What are the eligibility criteria for OSS?
To be eligible for OSS, a person must be: 65 years old or older or be blind or disabled if age 18 to 64 years old; a U.S. citizen or qualified noncitizen; a Florida resident; have a Social Security number or in the process of filing for one; file for any other benefits to which the individual may be entitled, including SSI payments; and disclose other third party insurance. The income limit varies by the type of facility that the individual resides. The asset limit is $2,000 for an individual and $3,000 for a couple. The individual’s income must be below the eligibility standard. Other technical requirements may apply. The individual must be certified by the state as needing to live in a licensed care facility. The Department of Children and Families (DCF) determines whether a person is eligible for OSS and should be contacted for further information regarding the program. DCF may be reached through their toll-free telephone number: 1-866-762-2237 or by email at: http://www.dcf.state.fl.us/ess/.
Will recipients have money for their personal needs?
All ACS recipients are entitled to keep a minimum of $54 for personal needs whether they receive an OSS payment or not.
How will recipients find out about the changes?
All OSS recipients who experience a change as a result of OSS/ACS re-design receive notices at least 10 days in advance from DCF explaining the changes. AFCH recipients will be receiving notices in December notifying them of the changes to come in January 2002. RTF residents will also be notified of any change resulting from the RTFs enrolling in ACS.
Will recipients experience any changes in their care as a result of ACS?
The services the resident receives are the same, assuming that these are the services the resident needs and that the facility is in compliance with licensure standards.
What will happen to recipients if the facility does not participate in ACS?
If the facility is qualified to participate in ACS but does not enroll, the facility may choose to keep the resident at the reduced provider rate ($698.40 per month as of January 2009). If the facility chooses to discharge the resident, the resident must be given a written notice at least 45 days in advance of the discharge. Case managers in the Department of Children and Families are prepared to assist any such residents with relocation to a participating facility.
