Understanding Medical Necessity for Florida Long-Term Care Medicaid

To qualify for Florida Long-Term Care Medicaid, an individual must demonstrate a medical and functional need for long-term care services, often referred to as meeting a nursing home level of care.

The Florida Department of Elder Affairs, through CARES, evaluates the individual's medical conditions, treatments, functional abilities, and need for ongoing care and assistance to determine medical eligibility.

Meeting nursing home level-of-care criteria does not mean your loved one must live in a nursing home. Depending on eligibility and individual needs, Medicaid Long-Term Care services may be provided in a nursing facility or through home- and community-based services.

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An Important Difference: Community-Based Care vs. Nursing Home Medicaid

The pathway to Florida Long-Term Care Medicaid is not exactly the same for everyone.

For individuals seeking home- and community-based Long-Term Care Medicaid services, including services that may help an individual remain at home or receive support in an assisted living or other community setting, the ADRC screening, priority ranking, and waitlist process generally apply.

For individuals seeking Medicaid payment for nursing facility care, the process differs from the community-based waitlist pathway. CARES is involved in determining whether the individual meets the required nursing facility level of care.

Our Florida Medicaid Specialists guide families to understand which pathway applies to their loved one and assist them through the appropriate steps.

The ADRC Screening & Interview

For individuals seeking home- and community-based services through Florida's Long-Term Care Medicaid program, the process generally begins with a screening through the local Aging and Disability Resource Center (ADRC).

The initial screening is completed by telephone with the individual and/or caregiver and generally takes approximately 45 minutes to one hour. The screening asks questions about the individual's health, functional abilities, daily care needs, living situation, and available support.

The screening generates a priority score and rank, which is used to determine placement on the Long-Term Care waitlist. Individuals with higher priority needs may be placed on the waitlist for Long-Term Care services.

If there is a significant change in the individual's health, living situation, caregiver support, or home environment, a rescreening may be requested.

Preparing for Your ADRC Interview

Our Florida Medicaid Specialists help families prepare for this important interview by reviewing the screening questionnaire with you in advance. We help you understand the questions and prepare to accurately communicate your loved one's medical, functional, cognitive, and daily care needs.

Being prepared helps ensure that the ADRC receives a clear and complete picture of your loved one's actual care needs and circumstances.

Medical Certification — Form 3008

For individuals proceeding through the community-based Long-Term Care enrollment process, once they are released from the waitlist, the ADRC provides the Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form 5000-3008, commonly referred to as the 3008.

The form must be completed by an authorized Florida medical provider and returned to the ADRC so the individual can continue through the medical eligibility process.

Our Medicaid & More team can help families coordinate the completion and submission of the 3008 and communicate with the appropriate healthcare providers so this important step continues moving forward.

The CARES Assessment

The Comprehensive Assessment and Review for Long-Term Care Services (CARES) program determines whether an individual meets Florida's medical eligibility and level-of-care requirements.

CARES assesses individuals seeking Medicaid nursing facility services as well as individuals seeking home- and community-based Long-Term Care Medicaid services.

The CARES assessment evaluates the individual's medical conditions, functional abilities, treatments, therapies, current services, and need for assistance with everyday activities.

The information gathered through the assessment is used to determine whether the individual meets the required medical level of care and to help identify the most appropriate long-term care setting and services.

Meeting Medical Eligibility

Once CARES determines that an individual meets the required level of care, the medical eligibility portion of the Florida Long-Term Care Medicaid process has been established.

Medical eligibility, however, is only one part of qualifying for Medicaid benefits. Applicants must also meet the applicable financial eligibility requirements, including Medicaid's income and asset requirements.

The Florida Department of Elder Affairs, through CARES, determines medical eligibility and level of care, while the Florida Department of Children and Families determines financial eligibility.

Learn More About Florida Long-Term Care Medicaid Eligibility

Income Limits for Long-Term Care Medicaid — Read More
Asset Limits for Long-Term Care Medicaid — Read More

You Don't Have to Navigate Medicaid Alone

Navigating Florida Long-Term Care Medicaid can feel overwhelming, especially when your family is already facing important healthcare and long-term care decisions. From understanding Medicare and Medicaid benefits to navigating medical and financial eligibility, our Florida Medicaid Specialists are here to guide you through each step of the process.

We help you understand what comes next, prepare for important interviews and assessments, organize and coordinate the necessary documentation, and keep your Medicaid application moving forward. You'll have a knowledgeable and compassionate team by your side—from your first consultation through Medicaid approval.

Our goal is simple: to make the Medicaid process easier for your family and help your loved one access the care and benefits they need to live their best life.

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More than Medicaid application specialists, we combine concierge Medicaid services with a geriatric care management approach to provide personalized guidance, trusted resources, and compassionate support.

As your guiding light through the Medicaid process, we’re here to help your family access the care, benefits, and resources needed to live life to the fullest. When legal guidance is needed, we’ll connect you with trusted elder law attorneys to help you explore the strategies and solutions that best fit your family’s needs.