Florida Medicaid Waiver

What Programs Are Available To Assist People With Disabilities in Florida?

Is there a Medicaid waiver program in Florida? Florida currently operates several Medicaid waiver programs including:

Florida Long-Term Care (LTC) Managed Care Program
Developmental Disabilities Individual Budgeting (iBudget) Waiver
Familial Dysautonomia Waiver;
Model Waiver;
Comprehensive Intellectual and Developmental Disabilities Managed Care Waiver

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Which state agency administers Medicaid waivers in Florida? The agency depends on the waiver. The Florida Agency for Health Care Administration (AHCA) administers the Long-Term Care Waiver, Familial Dysautonomia Waiver, Model Waiver, and Comprehensive Intellectual and Developmental Disabilities Managed Care Waiver. The Agency for Persons with Disabilities (APD) administers the iBudget Florida Waiver for people with developmental disabilities.

What programs assist people who have developmental disabilities in Florida? Florida’s main Medicaid waiver program for people with developmental disabilities is iBudget Florida, administered by the Agency for Persons with Disabilities (APD). Consumer-Directed Care Plus (CDC+) is a self-directed option within the iBudget waiver that gives participants more control over their budget and allows them to choose and hire their own service providers. Florida also offers the Intellectual and Developmental Disabilities Comprehensive Managed Care (ICMC) Program, a Medicaid managed care option that combines regular health care with home- and community-based services for eligible people with intellectual and developmental disabilities.

What is the best number to call to get started? For information about the iBudget Florida Waiver or services for people with developmental disabilities, contact the Agency for Persons with Disabilities (APD) at 1-866-APD-CARES (1-866-273-2273). For questions about other Florida Medicaid waiver programs or Florida Medicaid in general, contact the Agency for Health Care Administration (AHCA) Medicaid Helpline at 1-877-254-1055.

Is there a website?Florida’s Agency for Health Care Administration (AHCA) maintains a current list of Florida Medicaid waiver programs and related information on its Federal Waivers page.

Who Qualifies For Assistance?

What is considered a developmental disability in Florida? To qualify for services through Florida’s Agency for Persons with Disabilities (APD), a person must have a developmental disability that began before age 18 and is expected to continue indefinitely. APD serves people with intellectual disabilities, severe forms of autism, cerebral palsy, spina bifida cystica or myelomeningocele, Prader-Willi syndrome, Down syndrome, Phelan-McDermid syndrome, and Tatton-Brown-Rahman syndrome. Children ages 3 through 5 who are at high risk of a developmental disability may also qualify for services.

Are there income limits to receive services? Yes. For people applying for Florida Medicaid home- and community-based waiver services, the financial eligibility limit is $2,982 per month in income and $2,000 in countable assets for an individual. However, Medicaid waiver rules can be different from regular community Medicaid rules. Under certain 1915(c) Home and Community-Based Services waivers, institutional-style eligibility rules may be used, meaning the applicant can be treated as a “family of one.” In those cases, a parent’s or spouse’s income and assets may not be counted when determining the applicant’s Medicaid eligibility. Financial eligibility can vary depending on the waiver and the applicant’s circumstances, and the Florida Department of Children and Families (DCF) makes the final Medicaid financial eligibility determination.

How old do you have to be to start receiving services in Florida? Age requirements vary by waiver program. The iBudget Florida Waiver serves eligible individuals age 3 and older. The Familial Dysautonomia Waiver serves eligible individuals ages 3 through 64, while the Model Waiver serves medically fragile children and young adults through age 20. The Long-Term Care Waiver generally serves eligible adults ages 18 through 64 with qualifying disabilities and adults age 65 or older. The Comprehensive Intellectual and Developmental Disabilities Managed Care program serves eligible adults age 18 and older.

Is There a Waiting List For the iBudget Florida Waiver?

How long is the waiting list in Florida? There are reports of people waiting more than 10 years for the iBuget Florida Waiver. There is no set waiting time because people are enrolled based on priority and level of need, with those in crisis receiving highest priority.

How many people are on the waiting list in Florida? There are about 15,000 people with developmental disabilities in Florida waiting for iBudget Medicaid waiver services. Florida refers to this waiting list as "pre-enrollment."

How many people are currently receiving services in Florida? There are about 37,000 people with enrolled in Florida's iBudget Waiver.

What assistance is available while you wait?People waiting for the iBudget Florida Waiver may still qualify for other assistance. If they are already eligible for Medicaid, they may receive Medicaid State Plan services such as medically necessary personal care, home health services, durable medical equipment, and medical supplies, including incontinence supplies. APD also helps people in pre-enrollment develop a support plan and can connect families with community resources and other programs while they wait.

Is there priority preference for people who are in crisis? Yes, people with the most critical needs are served first.

What Services does iBudget Florida Offer & What Are The Service Limitations?

What services does the Florida Medicaid waiver program offer? iBudget Florida offers services based on each person’s individual needs and goals. Services are grouped into eight areas: Life Skills Development, Supplies and Equipment, Personal Supports, Residential Services, Support Coordination, Therapeutic Supports and Wellness, Transportation, and Adult Dental Services. Not everyone receives every service; services must be medically necessary and authorized as part of the person’s support plan.

Does Florida offer community group homes?Florida offers several community residential options for people with developmental disabilities, including group homes, assisted living facilities, behavior-focused homes, and specialized medical homes. Services may include Residential Habilitation for help with daily living and independence, specialized behavioral supports for people with significant behavior needs, and Specialized Medical Home Care for people with complex medical needs.

Does Florida offer supported living? Yes. Supported Living allows adults with developmental disabilities to live in their own home or apartment with individualized assistance. Supported Living Coaching helps people learn the skills needed to live as independently as possible, while Personal Supports can provide ongoing help with daily activities such as bathing, dressing, shopping, personal hygiene, and meal preparation.

Are there still state owned institutions in Florida? Yes. Florida currently operates two residential Developmental Disabilities Centers: Tacachale in Gainesville and Sunland Center in Marianna. These facilities serve people with intellectual and developmental disabilities who require institutional-level residential care. Together, Tacachale and Sunland serve approximately 450 residents. Florida also operates separate secure residential programs for people with developmental disabilities who are involved in the criminal justice system.

Is institutional care more expensive than community-based care? Yes. Institutional care is significantly more expensive than supporting people in the community. Based on current state funding and resident numbers, Florida spends roughly $286,000 per year for each person living in a state developmental disabilities center. By comparison, average annual iBudget waiver costs have been reported at about $28,700 for a person living with family and about $43,300 for a person living in their own home. Community-based services can therefore cost substantially less than institutional care while allowing people to remain in more integrated settings.

How Do You Select A Provider?

Do providers work for the state? No. iBudget providers are private providers, not state employees. iBudget waiver providers must meet APD provider qualifications and complete the APD enrollment process. They must also enroll as Florida Medicaid providers through the Agency for Health Care Administration (AHCA).

About how many providers are there in the state? There are about 1,000 providers in Florida.

Do you have a choice in providers? Yes, in Florida you are encouraged to select your own providers. WaiverProvider.com lists providers in Florida.

How Do You Become A Provider?

Call (727) 841-8943 to order information on becoming a provider in Florida.

Additional Information