Florida Medicaid’s PAC Waiver Changes

The 2017 Legislature amended the law to allow individuals who are diagnosed with AIDS to obtain and maintain Medicaid coverage without the need for enrollment in the PAC Waiver. This transition is anticipated to occur on January 1, 2018. In order to qualify, an individual must meet the criteria currently used for the PAC Waiver:

Most recipients enrolled in the PAC Waiver currently receive their medical, prescribed drugs, and acute care services from a Statewide Medicaid Managed Care - Managed Medical Assistance (MMA) health plan. There will be no change in how these individuals receive MMA services unless they choose to change plans. With the advances that have been made over the last decade in the treatment of HIV and AIDS, the majority of the people on the PAC Waiver do not use or need the home and community-based services offered through the waiver. As such, the recipients in the PAC Waiver who are only receiving case management services and do not need home and community-based services in order to safely remain in the community, will be dis-enrolled from the PAC Waiver, but will keep their Medicaid coverage. This means there will be no loss in services – they can continue to have access to their medications, see their doctors, and will receive case management from their current MMA plan.

The recipients in the PAC Waiver who have been receiving more than case management services through the PAC Waiver and who continue to need home and community-based services in order to live safely in the community will transition into the Statewide Medicaid Managed Care Long-term Care (LTC) program for their home and community-based service needs. These recipients will continue to maintain Medicaid eligibility and have access to their prescribed drugs and doctors through their current MMA plan. They will also continue to receive home and community-based services, which will be provided through an LTC plan. The Agency will provide these individuals with an opportunity to choose an LTC plan that can best meet their needs. The LTC program offers a more robust benefit package than the PAC Waiver, including enhanced case management standards and expanded benefits. The LTC program also offers recipients an opportunity to receive care/services through a program with enhanced quality outcome measures.

The Agency will use a number of different methods to maintain open lines of communication throughout the transition. We have already begun to reach out to recipients by telephone to ensure they understand what this transition means for them. We are also talking with PAC case management agencies and other stakeholder groups. The Agency is hosting monthly web-based meetings for interested stakeholders (PAC providers, recipients, etc.) to share information on the transition efforts.

Pre-Welcome Letters

PAC LTC - English [87KB]

PAC LTC - Spanish [88KB]

PAC LTC - Creole [19KB]

PAC MMA - English [87KB]

PAC MMA - Spanish [88KB]

PAC MMA - Creole [19KB]

Welcome and Reminder Letters

The Long-term Care program welcome and reminder letters can be viewed at: https://flmedicaidmanagedcare.com/LettersAndBrochures.aspx.  Additionally, you can view brochures that provide additional information related to the Long-term Care program.

Webinar Dates

Date Time Presentation
July 26, 2017 10:00 – 10:50 am, ET July PAC Presentation [770KB]
August 15, 2017 2:00 - 3:00 pm, ET August PAC Presentation [751KB]
September 19, 2017 2:00 - 3:00 pm, ET *Cancelled due to post Hurricane Irma recovery efforts
October 17, 2017 2:00 - 3:00 pm, ET October PAC Presentation [664KB]
November 14, 2017 2:00 - 3:00 pm, ET November PAC Presentation [771KB]
December 12, 2017 2:00 - 3:00 pm, ET December PAC Presentation [662KB]
Post-Transition Stakeholder Webinar: PAC, ACF, TBI/SCI
January 23, 2018 2:00 – 3:00 pm, ET  

All presentations will be made available following the scheduled webinar date. To register for the post-transition stakeholder webinars, please visit:   https://register.gotowebinar.com/register/4777463072459764481.

The Agency has begun reaching out to individuals enrolled in the PAC Waiver personally. Individuals may also contact the Agency at 1-877-254-1055 if they have additional questions.

Waiver Services

The Agency conducted a review of the LTC program to ensure that it offers services consistent with those received through the PAC Waiver. Below is the PAC Waiver and LTC Services comparison.

PAC Waiver Services Crosswalk

Current PAC Waiver Services Current PAC Waiver Procedure Codes SMMC Services SMMC Service
SMMC Procedure
Modifier 1
Case Management G9012 LTC/MMA Care Coordination/ Case Management G9002  
Chore – Other S5120 LTC Homemaker S5130  
Chore – Pest Control G9005 LTC Homemaker G9004
Day Health Care S5100 LTC Adult Day Health Care S5100  
Education and Support 95152 LTC Care Coordination/ Case Management G9002  
Environmental Accessibility Adaptations S5165 LTC Home Accessibility S5165  
Home Delivered Meals S5170 LTC Home Delivered Meals S5170  
Homemaker S5130 LTC Homemaker S5130  
Personal Care 99509 LTC Personal Care T1019  
Skilled Nursing (LPN) T1003 LTC Intermittent and Skilled Nursing, LPN T1003  
Skilled Nursing (RN) T1002 LTC Intermittent and Skilled Nursing, RN T1002 HN
Restorative Massage* 97124 MMA Restorative Massage 97124  
Specialized Medical Equipment and Supplies E1399 LTC/MMA Medical Equipment and Supplies/ Durable Medical Equipment E1399
Specialized Personal Care for Foster Children S5145 MMA Florida Medicaid covers children via the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which provides comprehensive and preventive health care services for children under age 21.  
Therapeutic Management of Substance Abuse T1007 MMA Behavioral Health Services H2020
* This is a historical code. Plans have the flexibility to determine the appropriate code(s) to use for a service. New service   added for individuals where the service is medically necessary and have a diagnosis of AIDS.