Florida Medicaid Waivers & Home and Community Based Programs Overview
- Waiver Policy Analyst
- Nov 21, 2024
- 2 min read
Updated: Mar 23
Florida, known as The Sunshine State, has a well-established Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.
Administered by the Agency for Health Care Administration (AHCA) in collaboration with the Florida Department of Elder Affairs (DOEA) and the Agency for Persons with Disabilities (APD), the state’s Medicaid program operates under a managed care model through the Statewide Medicaid Managed Care – Long-Term Care (SMMC-LTC) Program.
Key waiver programs include the iBudget Waiver, which serves individuals with intellectual and developmental disabilities (IDD), the Long-Term Care (LTC) Waiver, which provides personal care and nursing services for seniors and individuals with disabilities, and the Family Supported Living Waiver, which promotes community integration for people with disabilities. Florida also offers Consumer-Directed Care Plus (CDC+), a self-directed option that allows waiver participants to hire and manage their own caregivers.
Regulatory oversight in Florida is managed through AHCA, APD, and DOEA, with additional licensing and compliance requirements enforced by the Florida Department of Health (DOH) and the Agency for Health Care Administration's Health Facility Regulation (HFR). Managed Care Organizations (MCOs) administer most HCBS services, ensuring cost-effective service delivery and comprehensive care coordination. Florida has implemented Electronic Visit Verification (EVV) requirements for personal care services, enhancing accountability and preventing fraud in home-based care.
Additionally, the iBudget Waiver uses a flexible, individualized budget model, allowing participants to tailor their services based on personal needs. With a focus on managed care integration, self-direction, and value-based service delivery, Florida’s Medicaid waiver programs ensure that individuals receive high-quality, community-based supports while maintaining independence and inclusion within their communities.
Providers must navigate complex Medicaid billing, compliance reporting, and managed care coordination to operate successfully within Florida’s HCBS framework.
Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.
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