Palm Beach County Caregiver and Long-Term Care Resources

A tour shows you the lobby. The questions below help you learn how the building works on an ordinary Tuesday night. Print the list, or tick the boxes on your screen as you go. Your ticks stay on this device. They are not saved or sent anywhere.

Ask the same questions at every facility so you can compare answers side by side. Ask for written copies of anything important, such as the admission agreement, the bed-hold policy and the list of extra charges.

Print this checklist

Several of these questions have legal anchors. Florida law says a Medicaid-certified nursing home may not transfer or discharge a resident solely because their source of payment changes. Any admission document that tries to waive that right is void (Fla. Stat. §400.022(1)(p)).

Federal rules say a facility may not require a third-party guarantee of payment as a condition of admission (42 C.F.R. §483.15(a)). It may ask someone with legal access to the resident’s money to pay from the resident’s own funds. Federal rules also bar a facility from asking for a promise that the resident will not apply for Medicaid.

For a hospital stay, Florida law requires the facility to tell a Medicaid resident how long their bed will be held, which is up to 15 days while Medicaid pays for it (§400.022(1)(u)).

Florida sets minimum staffing for nursing homes. It requires a weekly average of at least 3.6 hours of direct care per resident per day, including at least 2.0 hours from certified nursing assistants and 1.0 hour from licensed nurses (Fla. Stat. §400.23(3)(b)). These are minimums, not targets. Asking how the building staffs above them is fair.

Under federal rules, a written care plan must be developed within 7 days after the resident’s comprehensive assessment. It is prepared by a team that includes the physician, a nurse and a nurse aide, with the resident and their representative taking part to the extent practicable (42 C.F.R. §483.21). Florida law also gives residents the right to take part in planning their medical treatment (§400.022(1)(j)).

Federal rules list the limited reasons a facility may transfer or discharge a resident against their wishes. They include needs the facility cannot meet, improved health, danger to others’ safety or health, nonpayment after reasonable notice, and closure.

The facility must usually give written notice at least 30 days ahead, with shorter notice allowed in emergencies and some other situations. The notice must state the reason, the appeal rights, and contact details for the State Long-Term Care Ombudsman, and a copy goes to the Ombudsman (42 C.F.R. §483.15(c)). Florida law sets the same 30-day standard (§400.022(1)(p)).

The Long-Term Care Ombudsman Program is free and confidential, at 1-888-831-0404 (Ombudsman).

An arbitration agreement means a dispute would go to a private arbitrator instead of a court. Under federal rules, a nursing home may not require one as a condition of admission or of continued care, and it must tell you that in writing. The agreement must give you 30 calendar days after signing to cancel it (42 C.F.R. §483.70(m)).

Many families take the admission packet home and read it before signing. If something in it is unclear, that is a good time to ask a lawyer.

Your notes (stay on this device)

Florida Medicaid long-term care is not one form. It is a few separate steps, run by different agencies:

• a screening or medical assessment, which looks at the care the person needs;
• a financial application to the Department of Children and Families (DCF), which looks at income and assets;
• a managed-care plan, which delivers the services once someone is enrolled.

The order depends on where the person lives now. Someone at home or in assisted living who wants services through the Statewide Medicaid Managed Care Long-Term Care program (SMMC LTC) usually starts with a phone screening. Someone already in a nursing home who needs nursing-home Medicaid, called the Institutional Care Program (ICP), usually focuses on the CARES assessment and the DCF application.

The steps below explain each stage in plain English. They are general education. What applies to your family depends on the facts.

For care at home or in assisted living, the first step into SMMC LTC is a screening by an Aging and Disability Resource Center (ADRC), according to AHCA.

In Palm Beach County, the ADRC is the Area Agency on Aging of Palm Beach/Treasure Coast. Its helpline is 1-866-684-5885, Monday through Friday, 8 a.m. to 5 p.m., and it serves Palm Beach, Martin, St. Lucie, Indian River and Okeechobee counties. From anywhere in Florida, the statewide Elder Helpline at 1-800-963-5337 (1-800-96-ELDER) can connect you to the right ADRC.

The screening is done by phone with the person or a caregiver and takes about 45 minutes to an hour. It produces a priority score.

After the screening, the Department of Elder Affairs sends a written notice of the person’s priority rank. People with a high priority rank are placed on the SMMC LTC waitlist. People with a low rank are given information about other community resources.

AHCA explains that people are released from the waitlist each month based on priority score and frailty level, not on how long they have waited. If something big changes, ask the ADRC for a rescreening. Examples of a big change include a fall or hospital stay, a move, losing a caregiver or spouse, or damage to the home.

CARES stands for Comprehensive Assessment and Review for Long-Term Care Services. AHCA says CARES must assess anyone who asks Medicaid to pay for nursing-facility care or for home and community-based services through SMMC LTC.

A nurse or assessor usually visits the person where they live, and there is no charge. A physician or registered nurse then reviews the file and decides the level of care. CARES answers the medical question only: does this person need this level of care? Money is a separate step.

DCF decides financial eligibility for most Medicaid long-term care. If someone already receives SSI, Social Security may decide instead, according to DCF. Most families apply online through the MyACCESS portal. DCF says the online application takes most people about 30 minutes, and you can sign it electronically.

You can also apply at a DCF office or a community partner, or mail a paper application to the Office of Economic Self Sufficiency Mail Center, P.O. Box 1770, Ocala, FL 34478-1770 (DCF).

Timing matters. For adults 21 and older, Florida Medicaid generally starts no earlier than the first day of the month DCF receives the application (AHCA). Florida no longer offers three months of retroactive coverage to most adults.

DCF tells you in a written notice exactly what it needs, and it sets a deadline. Upload the documents to your MyACCESS account, or mail, fax or drop them off. Write the ACCESS or case number, the applicant’s name and date of birth, and a phone number on every page (DCF).

The look-back period is the 60 months before the application that Medicaid reviews for gifts and transfers made for less than fair value (42 U.S.C. §1396p(c)). A transfer in that window may delay eligibility.

DCF reviews each application and decides whether it needs an interview. If it does, it sends a pending notice, either to your MyACCESS account or by mail, depending on the contact preference you chose. Signing up for email alerts on MyACCESS usually gets these notices to you faster.

After you upload documents, allow about three days for your account to show that DCF received them. Keep a copy of everything you send, along with the date. A missed deadline is one of the common reasons an application stalls.

Federal rules require a Medicaid decision within 45 days, or within 90 days when eligibility depends on a disability decision (42 C.F.R. §435.912).

If the application is approved, DCF mails a Medicaid card, and AHCA sends Choice Counseling information so the person can choose a managed-care plan. If any part is denied, the notice explains why. DCF sends it by mail and posts it in your online account (DCF). Read it closely, because notices can carry deadlines for asking questions or requesting a hearing.

Approval is often not the last step. A nursing home resident may still owe part of their monthly income to the facility, and the plan must still arrange the services.

A hypothetical: a daughter in Boca Raton notices that her 84-year-old father can no longer manage at home alone. She might call the Area Agency on Aging helpline for an SMMC LTC screening. She would then gather his bank statements and Social Security letter while waiting for the CARES visit, and file the ACCESS Florida application on MyACCESS as soon as the family understands where he stands.

If he moved to a nursing home first, the family might shift its focus to CARES and the ICP application. Every family’s order of steps can differ.

If the family’s question is how income, savings, the home or past gifts fit the Medicaid rules, call Solkoff Legal, P.A. at (561) 733-4242 before you file.