Florida Medicaid HCBS waivers are the most fragmented home and community-based services (HCBS) system in the nation. Where most states run one or two waivers, Florida runs three primary engines, one new managed-care alternative, several PACE organizations, two niche legacy waivers, and a new family-caregiver pay program under its 1115 demonstration. Each pathway has its own eligibility test, its own waiting list (or lack of one), its own paid-family-caregiver rules, and its own application phone number.

If you have a parent with Alzheimer's, a child with autism, an adult son or daughter with cerebral palsy, a relative on private duty nursing, or a spouse approaching age 55 in fragile health, the right waiver for your family is almost certainly not the same one your neighbor needs. Picking the wrong door costs years.

This guide is the map. We cover every active HCBS pathway in Florida for 2026, the eligibility math behind each one, the waitlists you can expect, the paid-caregiver options inside each program, and a navigation decision tree at the end so you can find your starting point in five minutes.

Florida Medicaid HCBS waivers compared: every pathway in one table

Pathway Operator Target population Functional eligibility Waitlist / capacity Paid family caregiver?
SMMC LTC AHCA + DOEA (CARES) Frail elderly 65 and over and disabled adults 18 to 64 Nursing-facility level of care Frailty-ranked release list Yes (PDO; spouses allowed)
iBudget APD IDD diagnoses (ID, autism, CP, spina bifida, Down syndrome, Phelan-McDermid, Prader-Willi) ICF/IID level of care Pre-enrollment list, roughly 17,000 to 21,000 Yes (CDC+; parents of minor children, narrower spouse rules)
ICMC AHCA / Florida Community Care Adults with IDD (waitlisted or already on iBudget/LTC) ICF/IID level of care Capacity set by expansion; voluntary Yes (within plan)
PACE AHCA + CMS via PACE org Adults 55 and over in a PACE service area Nursing-facility level of care Capacity varies by area; often open Limited, staff-delivered model
FHHA AHCA via 1115 MMA demonstration Medically fragile children under 21 on PDN PDN-eligible Provider-capacity limited Yes (parents, relatives)
Model Waiver AHCA Medically complex/fragile children Hospital or NF level of care Roughly 20 slots Limited
FD Waiver AHCA Familial Dysautonomia, at risk of hospitalization At risk of hospitalization Roughly 15 participants Limited

Read this table sideways. Eligibility is age plus diagnosis plus functional level, not just income. A 15-year-old with autism cannot use SMMC LTC even if her family income qualifies: wrong age and wrong functional eligibility (ICF/IID, not nursing-facility level of care). A 70-year-old with Down syndrome could theoretically be served by either SMMC LTC or iBudget, and the choice has major consequences for residential placement and family caregiver pay.

The rest of this guide walks each pathway in the order you'd consider them by age and diagnosis.

SMMC LTC: Florida's primary HCBS waiver for older adults and physically disabled adults

The Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program is Florida's largest home and community-based services (HCBS) pathway by enrollment. It is a combined 1915(b)/1915(c) authority operated by the Florida Agency for Health Care Administration (AHCA) in partnership with the Florida Department of Elder Affairs (DOEA). It covers Medicaid recipients age 65 and over, plus disabled adults age 18 to 64, who require nursing-facility level of care, delivered through capitated managed-care plans across Florida's SMMC regions.

We cover SMMC LTC at full depth in our Florida Long-Term Care Waiver guide. The short version:

  • Functional eligibility: Nursing facility level of care, screened by DOEA through the CARES (Comprehensive Assessment and Review for Long-Term Care Services) Bureau. The screen confirms activities-of-daily-living deficits, with cognitive impairment factored in.
  • Financial eligibility: Institutional Medicaid rules apply. In 2026, the monthly income limit is $2,982 for a single applicant (300% of the $994 Supplemental Security Income (SSI) federal benefit rate) and the countable-asset limit is $2,000 for an individual, excluding the homestead, one car, and prepaid burial. The SSI federal benefit rate is set by the federal government and updated annually.
  • Waitlist: Florida runs a frailty-ranked release list, not a strict chronological waitlist. By statute (F.S. 409.979), the Department of Elder Affairs maintains a statewide wait list and uses an assessed priority score, not application date, to set the order for releasing individuals into the program. See the long-term-care-waiver guide for current release dynamics.
  • Paid family caregiver: Yes, through the Participant-Directed Option (PDO). Under the PDO, an enrolled community-dwelling member can directly hire, train, schedule, and supervise their own caregiver, including a family member, and in Florida a spouse, for a defined subset of services (adult companion care, attendant nursing care, homemaker, personal care, and intermittent and skilled nursing; in-home respite is delivered by network providers rather than through PDO). See our Florida Long-Term Care Waiver guide for how to enroll.
  • What it covers: The minimum SMMC LTC service array includes adult companion care, adult day health care, attendant care, assisted living facility services (with room and board paid by the member), home accessibility adaptation, home-delivered meals, homemaker, hospice, intermittent and skilled nursing, nursing-facility transition, personal care, and respite, the supports that let a frail older adult or physically disabled adult live in the community instead of in a nursing facility.

Bottom line: if you're researching a Florida pathway for a parent over 65 or a physically disabled adult under 65, SMMC LTC is your primary engine and the long-term-care-waiver guide is your starting point.

iBudget Florida: the IDD waiver

iBudget Florida is the state's primary 1915(c) HCBS waiver for individuals with intellectual or developmental disabilities (IDD). It is operated by the Florida Agency for Persons with Disabilities (APD) under Florida Statutes section 393.0662. The allocation methodology and Questionnaire for Situational Information (QSI) assessment it uses are set in that statute and in Florida Administrative Code Rules 65G-4.0213 through 65G-4.0218.

iBudget is slot-limited and not an entitlement: by statute, the total of all clients' projected annual iBudget expenditures may not exceed APD's appropriation for waiver services. Tens of thousands of Floridians are served on the waiver, and the pre-enrollment list, what most families call the "waitlist", runs in the range of roughly 17,000 to 21,000 individuals depending on the count and date. Because exact counts move and are reported differently by different trackers, verify the current number against APD's county-level posting before relying on it. Under HB 1103 (2025), APD must post the pre-enrollment list at the county level every five days.

Who qualifies for iBudget

Three eligibility pathways must all be cleared:

  1. Diagnostic. The applicant must have one of the qualifying diagnoses under Florida Statutes section 393.063, intellectual disability, autism, cerebral palsy, spina bifida, Down syndrome, Phelan-McDermid syndrome, or Prader-Willi syndrome, that manifested before age 18 and constitutes a substantial handicap. APD adjudicates this prong.
  2. Functional. The applicant must meet the ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities) level of care, determined by APD review. This is not the same as the nursing-facility level of care used for SMMC LTC.
  3. Financial. Institutional Medicaid rules apply. In 2026, that is a monthly income limit of $2,982 for a single applicant (300% of the SSI federal benefit rate) and a $2,000 countable-asset limit for an individual. The Florida Department of Children and Families (DCF), through ACCESS Florida, adjudicates the financial prong.

Important: APD must determine sufficient funding before offering a slot. Even if all three eligibility prongs are met, an applicant joins the pre-enrollment list and waits, often for years in the non-crisis categories.

The seven waitlist categories

Under Florida Statutes section 393.065, APD assigns each applicant to a pre-enrollment category and provides priority in a set statutory order, with Category 1 (crisis) given first priority in moving from the pre-enrollment categories into the waiver:

Category Description Eligibility-determination clock
1 (Crisis) Homelessness, danger to self or others, caregiver unable to give care First priority
2 Child welfare youth transitioning Standard
3 Caregivers with documented inability to continue within 12 months; substantial incarceration/court-commitment risk; behaviors endangering self or caregiver; discharge from state mental health hospital or skilled nursing facility Standard
4 Caregivers age 70+ with no alternate caregiver Standard
5 Clients expected to graduate secondary school within 12 months needing employment, day, or postsecondary support Standard
6 Adults 21+ not meeting Categories 1-4 Standard
7 Individuals under 21 not meeting Categories 1-4 Standard

Within Categories 3 through 7, the order is date of eligibility determination, first determined, first served. A family who applies the day their child receives an autism diagnosis at age 4 will likely move through Category 7 to Category 6 around age 21, then wait for funding to release a Category 6 slot. Real-world timelines can stretch a decade or more.

If your circumstances change, a caregiver's health worsens, a young adult is about to age out of school services, a sibling-caregiver receives a serious diagnosis, request a category review immediately. APD's iBudget customer line is 1-866-273-2273.

How the iBudget allocation works

Once a slot is offered, APD does not simply hand out a flat amount. The allocation methodology is a statistically validated formula combining age, living setting, and the applicant's Questionnaire for Situational Information (QSI) factor scores. The QSI is a mandatory standardized assessment capturing behavioral, functional, and physical needs along with life circumstances.

From the resulting individual budget, the support coordinator and family build a cost plan, a written plan that distributes the budget across allowable services. Individual allocations vary widely by need; APD does not publish a single standard amount, so verify your projected budget with your support coordinator.

If the formula allocation is genuinely insufficient, for example, a client with high behavioral needs requiring intensive residential habilitation, the family can request Significant Additional Needs (SAN) supplemental funding under Florida Administrative Code Rule 65G-4.0218.

What iBudget covers

The iBudget service array is comprehensive and uniquely IDD-focused. Covered services include:

  • Adult day training (Life Skills Development Level 3)
  • Behavior analysis services and behavior assistant services
  • Companion services
  • Consumable medical supplies
  • Dental services (waiver-funded supplemental, on top of the PDHP plan)
  • Dietitian services
  • Durable medical equipment and specialized medical equipment
  • Environmental accessibility adaptations (home modifications)
  • In-home support services (IHSS)
  • Life Skills Development Levels 1 through 3
  • Live-in support and live-in residential habilitation
  • Occupational therapy
  • Personal emergency response systems
  • Personal supports (adults, ADLs, meal prep, hygiene)
  • Physical therapy
  • Private duty nursing
  • Residential habilitation across four tiers (Standard, Behavior-Focused, Intensive Behavior, Enhanced Intensive Behavior)
  • Residential nursing services
  • Respiratory therapy
  • Respite care
  • Skilled nursing
  • Special medical home care
  • Specialized mental health counseling
  • Speech therapy
  • Support coordination (mandatory case management)
  • Supported employment
  • Supported living coaching
  • Transportation

Several of these, behavior analysis, supported employment, supported living coaching, residential habilitation tiers, adult day training, are unique to iBudget and not available through SMMC LTC. Conversely, SMMC LTC covers ALF room and board, adult day health, and hospice that iBudget does not.

Consumer-Directed Care Plus (CDC+), paid family caregivers in iBudget

For a parent who has been providing hands-on care without pay, the practical question is usually whether a family member, especially a spouse, can be hired and paid, and the answer differs by program. Consumer-Directed Care Plus (CDC+) is iBudget's self-direction option, referenced in Florida Statutes section 393.0662, that lets an enrollee or their representative act as the employer of record. Inside CDC+:

  • The consumer (or a designated representative) becomes the employer of record.
  • The consumer hires, supervises, and manages workers under a monthly budget.
  • Workers do not have to be enrolled Medicaid providers, but they must clear the AHCA Clearinghouse background screening.
  • A Fiscal/Employer Agent (F/EA) handles payroll, taxes, and workers' compensation.

For families: parents of minor children on iBudget can be paid for self-directed personal care through CDC+. Spouses can be paid for approved services in some configurations, but paid-spouse status under iBudget is narrower than under SMMC LTC's PDO. Verify the current CDC+ Program Handbook for spouse-as-paid-worker conditions before assuming a spouse can be hired.

The CDC+ Helpline is 1-866-761-7043.

For our complete guide to paid family caregiving in Florida, including the SMMC LTC PDO, CDC+, the Veterans Aid & Attendance benefit, and FHHA, see How to Get Paid as a Family Caregiver in Florida.

Recent legislative changes affecting iBudget

Each year's appropriation funds only a limited number of new slot offers, so net waitlist reduction tends to be marginal. Meaningful waitlist relief requires either a much larger appropriation or a structural shift such as ICMC growth. Because the dollar amounts and slot counts change every budget cycle, check the current year's APD legislative budget request for the figures that apply to your situation.

ICMC: the new IDD managed-care alternative

The Intellectual & Developmental Disabilities Comprehensive Managed Care (ICMC) program is Florida's newest IDD pathway and the most consequential structural change in the state's IDD landscape in a decade. Created by SB 2510 (2023) as a voluntary managed-care alternative, ICMC moved to statewide rollout on October 1, 2025 under operator Florida Community Care (FCC).

The most important date to circle on the calendar: July 1, 2026. On that day, ICMC opens enrollment to individuals already enrolled on the iBudget waiver or the SMMC LTC waiver. Choosing ICMC removes the member from the iBudget pre-enrollment list (and, for an iBudget enrollee, transfers the member out of iBudget into ICMC), but is voluntary and disenrollable. A family that tries ICMC and decides it isn't working can return to iBudget, though there can be timing implications.

ICMC combines MMA medical, LTC, and DD waiver-style services into one capitated managed-care plan. Plans add expanded benefits typical of capitated managed care, gym memberships, grocery cards, summer camp scholarships, that traditional iBudget does not offer.

The trade-off: traditional iBudget gives families maximum flexibility under fee-for-service rules and the CDC+ self-direction option. ICMC trades some of that flexibility for integrated medical/behavioral/LTC management under one plan plus expanded benefits. For some families, especially those who find coordinating across MMA, the dental plan, and iBudget exhausting, that trade is worth it. For others, the loss of fee-for-service flexibility outweighs the simpler administration.

If you're on the iBudget pre-enrollment list right now, the question for July 1, 2026 is: does ICMC give my family functional access faster than waiting for an iBudget slot? Because choosing ICMC removes you from the iBudget list, this is not a costless decision. We recommend talking with your APD support coordinator and the FCC enrollment line before opting in.

PACE: Florida's Program of All-Inclusive Care for the Elderly

The Program of All-Inclusive Care for the Elderly (PACE) is a federally authorized integrated care model under sections 1894 (Medicare) and 1934 (Medicaid) of the Social Security Act (42 U.S.C. 1395eee and 1396u-4). It is a capitated dual-program model that integrates Medicare and Medicaid in a single entity. The PACE organization receives a fixed monthly payment per member from each program and is responsible for all of the member's medical, behavioral, long-term care, and end-of-life needs.

Florida operates several PACE organizations across the state in 2026. AHCA is the contracting Medicaid agency; CMS oversees the Medicare side.

PACE eligibility

  • Age 55 or older. PACE is the only HCBS pathway in Florida that uses 55 as the floor; every other engine (except FHHA for children) starts at 65 or covers all ages.
  • Meets nursing-facility level of care, determined by DOEA through the CARES Bureau.
  • Lives in a PACE service area. PACE coverage is geographic, not statewide.
  • Able to live safely in the community with PACE support.

Most PACE participants are dual-eligible, enrolled in both Medicare and Medicaid, because that is where the financial integration delivers the largest benefit. Florida has historically had substantial unused PACE capacity, so many service areas have open enrollment. Verify current capacity and enrollment in your area against AHCA's most recent PACE Monthly Report.

Cost to the member

  • Dual-eligible (Medicare + Medicaid): No monthly premium and no cost-sharing for covered PACE services.
  • Medicaid-only: Pays any applicable share of cost under the Personal Needs Allowance (PNA) rules.
  • Medicare-only or private-pay: Pays the full PACE premium, which is substantial and generally not used by middle-income families without long-term care insurance.

Finding a Florida PACE organization in 2026

PACE coverage is local, and the provider roster changes as organizations add sites and service areas. Established Florida providers serve metro areas including Miami-Dade and Broward, Palm Beach County, the Tampa Bay region, and Southwest Florida, with additional providers in other counties. Because the roster and service-area boundaries shift, do not assume a provider near you exists or has open slots without checking.

To find your local organization, use the Florida PACE Providers Association directory, then verify current coverage and capacity against AHCA's most recent PACE Monthly Report before applying.

FHHA: the family-caregiver-as-paid-aide program for medically fragile children

The Family Home Health Aide (FHHA) Services Program is Florida's newest HCBS-adjacent pathway and one of the most consequential for parents of medically fragile children. It is authorized under Florida's Managed Medical Assistance (MMA) section 1115 demonstration. FHHA is not a 1915(c) waiver and not a 1915(i) state-plan option; it lives inside the 1115 MMA demonstration and is delivered through MMA managed-care plans.

Who FHHA serves

Medically fragile children under age 21 who are eligible for Private Duty Nursing (PDN). These are children with tracheostomies, ventilator dependency, complex feeding needs, or other conditions requiring continuous skilled nursing oversight at home.

What FHHA changes

Before FHHA, a family member who provided hands-on care for a medically fragile child did so unpaid while a separate home health aide was billed to Medicaid for the same hours of care. FHHA closes that gap: a parent, guardian, or caretaker relative can now train, become employed by a licensed home health agency, and receive Medicaid reimbursement for FHHA aide services delivered to the child, under non-related Registered Nurse supervision.

The training and supervision model

  • Home health aide training meeting at least the 75-hour federal Conditions of Participation floor for Medicare and Medicaid home health aides, with SB 1156 (2025) directing a Florida curriculum in that range. Confirm the exact current hour requirement with the participating agency.
  • Non-related Registered Nurse supervision required. A related RN (the child's mother who is also an RN, for instance) cannot serve as the supervising nurse. Supervision must come from outside the family.
  • Child-specific instruction for advanced tasks delegated by the RN after demonstrated competency.

The utilization caps

Under SB 1156 (2025), FHHA utilization limits are set at 12 hours per day and 40 hours per week, with exceptions allowed when medically necessary. These caps were added in response to concerns about overlap with school-day private duty nursing and to align FHHA with broader home health workforce norms.

What's still open

AHCA submitted a CMS waiver request (reported around August 2025) seeking an income disregard so family caregiver earnings don't count against the child's Medicaid eligibility, and permission for pediatric specialty PDN providers to bill for FHHA services. Final CMS approval status on these requests is not confirmed as of mid-2026, so treat the income disregard as not yet in effect until you verify it with AHCA or the participating agency. Without the disregard, families have to manage the risk that the parent's FHHA earnings push the child over the Medicaid income limit, a genuinely thorny problem that some families solve with pooled trusts or careful budgeting.

Children served in 2026

AHCA has not published a final enrollment figure. Industry reporting from the Home Care Association of Florida describes strong early interest from families and a large share of surveyed home health agencies planning to participate, but no official count is available yet. Expect FHHA enrollment to grow through 2026 and 2027 as agency capacity expands.

Niche legacy waivers: Model Waiver and Familial Dysautonomia (FD) Waiver

Two narrow-population 1915(c) waivers continue to operate in 2026, both small but consequential for the families who qualify.

Model Waiver (1915(c), FL.40166.R06)

  • Operator: AHCA.
  • Target: Medically complex or fragile children, including children with degenerative spinocerebellar disease.
  • Capacity: Roughly 20 children, one of the smallest waivers in the state.
  • Why it matters: The Model Waiver allows certain children to qualify for Medicaid based on the child's own situation rather than parental income, a critical feature for middle-income families whose child would otherwise be ineligible because of parental earnings.
  • Watch for changes: Florida has signaled interest in redesigning and broadening the Model Waiver, the first significant change to it in many years. Because the redesign's scope and timeline are still being set, families with medically fragile children who don't currently qualify should ask AHCA whether expanded eligibility applies to their child before assuming it does.

Familial Dysautonomia (FD) Waiver (1915(c), FL.40205.R04)

If your family fits FD or Model Waiver criteria, contact AHCA's Medicaid Helpline at 1-877-254-1055 for application guidance.

What Florida does NOT operate in 2026

Three federal HCBS authorities exist that Florida is not currently using:

Money Follows the Person (MFP), Florida is NOT an MFP state in 2026

The federal Money Follows the Person (MFP) demonstration grant helps states transition Medicaid beneficiaries from institutions back into community settings. Florida received an MFP grant in 2011 but withdrew in 2013 and has not re-participated, even though the federal program has since been extended. This means Florida lacks a dedicated funding stream for nursing-home-to-community transitions; that work happens within SMMC LTC and individual managed-care plans without a dedicated MFP budget.

1915(i) State-Plan HCBS Option, Florida does NOT operate this option

A 1915(i) state-plan option lets states offer HCBS as a state-plan benefit (an entitlement) rather than through a slot-limited waiver. Florida does not operate a 1915(i) state-plan HCBS option. All Florida HCBS funding flows through 1915(c) waivers, the 1115 MMA demonstration, or the combined 1915(b)/1915(c) SMMC LTC authority.

Project AIDS Care (PAC) waiver, TERMINATED December 1, 2017

The Project AIDS Care (PAC) waiver historically served Floridians with an AIDS diagnosis. It was terminated December 1, 2017, after the 2017 Florida Legislature amended state law so AIDS-diagnosed individuals can obtain and maintain Medicaid without PAC enrollment. Former PAC participants moved to MMA. The Long-Term Care Community Diversion Pilot Project (LTCCDPP) was likewise discontinued when Florida moved to statewide SMMC LTC under the 2011-2013 reform legislation.

If you find an old website, Reddit thread, or even a (sadly out-of-date) provider page referencing PAC or LTCCDPP, that information is at least eight years stale.

Which Florida Medicaid HCBS waiver should I apply for? A decision tree

Use this triage, then verify with the program operator before committing.

Under 21 with IDD diagnosis → Apply for iBudget as early as possible. Expect a multi-year wait. Watch for Category 1 (Crisis) eligibility if circumstances deteriorate.

Under 21, medically fragile, on Private Duty Nursing → Apply for FHHA (immediate paid-family-caregiver opportunity) and ask about the Model Waiver (especially if your child has a degenerative spinocerebellar disease diagnosis, and watch for the planned redesign that may broaden eligibility). If the child also has an IDD diagnosis, apply for iBudget in parallel.

Adult 18+ with IDD → iBudget is your primary engine. Consider ICMC starting July 1, 2026 if you're already enrolled in iBudget or LTC and the integrated managed-care model fits your family.

Adult 55 to 64, dual-eligible, needing comprehensive integrated care, in a PACE service area → PACE is often the best choice if available where you live. Florida has historically had substantial unused PACE capacity, so many areas have open enrollment.

Adult 18+ with physical disability → SMMC LTC.

Adult 65+ with frailty, ADL deficits, or cognitive decline → SMMC LTC. Add PACE to the consideration set if dual-eligible and in service area.

Confirmed Familial Dysautonomia diagnosis, at risk of hospitalization → FD Waiver (very small, but the right pathway if you qualify).

Important federal rules

  • Only one 1915(c) waiver enrollment at a time. A child cannot be on iBudget and the FD Waiver simultaneously.
  • Choosing ICMC removes you from the iBudget pre-enrollment list. This is a one-way door (with a return option that has timing implications), don't opt in lightly.
  • PACE replaces both Medicare and Medicaid managed-care enrollment. When you join PACE, the PACE organization becomes responsible for all your Medicare and Medicaid services. You cannot keep your existing Medicare Advantage plan or MMA plan.
  • State plan benefits (home health, FHHA via 1115) can run alongside a 1915(c) waiver for medically fragile children since FHHA is 1115-authorized, not 1915(c).

Application resources: phone numbers and websites

Save these. You'll use most of them.

DCF ACCESS Florida (financial eligibility) Determines the financial Medicaid eligibility (income and assets) that every HCBS pathway requires; takes applications and renewals for institutional and community Medicaid. 1-866-762-2237 myflfamilies.com/services/public-assistance
DOEA Elder Helpline / SMMC LTC release list Your first call for an older parent or physically disabled adult; routes you to the local Aging and Disability Resource Center (ADRC) and the CARES level-of-care screen for the SMMC LTC release list. 1-800-963-5337 elderaffairs.org
APD iBudget customer line Adds you to the iBudget pre-enrollment list, answers waitlist-category questions, and processes category reviews when your circumstances change. 1-866-273-2273 apd.myflorida.com/ibudget
APD main line and area offices The Agency for Persons with Disabilities' general line; APD also runs 14 regional and area offices statewide for in-person support with iBudget and CDC+. (850) 488-4257 apd.myflorida.com
Consumer-Directed Care Plus (CDC+) Helpline Supports iBudget self-direction: becoming employer of record, hiring and paying workers (including some family members), and managing the monthly budget. 1-866-761-7043 apd.myflorida.com/cdcplus
AHCA Medicaid Helpline The Agency for Health Care Administration's general Medicaid line; handles Model Waiver and FD Waiver application guidance and broad Medicaid questions. 1-877-254-1055 ahca.myflorida.com
Choice Counseling (SMMC enrollment) Free enrollment help for choosing and switching Statewide Medicaid Managed Care plans, including SMMC LTC plans. 1-877-711-3662 flmedicaidmanagedcare.com
Florida PACE Providers Association Directory of the state's PACE organizations and their service areas, so you can find and contact the PACE program that covers your county. flpace.org
Florida Senior Legal Helpline Free legal advice for Floridians age 60 and over, including HCBS eligibility denials, waiver appeals, and Medicaid-planning questions. 1-888-895-7873 floridaseniorlegalhelpline.org
Disability Rights Florida The state's protection-and-advocacy organization; legal advocacy for IDD and disability-rights issues, including waiver-access disputes. disabilityrightsflorida.org

Frequently Asked Questions

Can my child be on iBudget and SMMC LTC at the same time?

No. Federal Medicaid rules permit only one 1915(c) waiver enrollment at a time. Pick the one that matches your child's diagnosis and functional level: IDD points to iBudget, while physical disability without an IDD diagnosis points to SMMC LTC (at age 18 and over).

What's the actual wait time for iBudget?

For non-crisis categories, historical waits have run for years, sometimes a decade or more, because slots release only as funding allows. Crisis (Category 1) gets first priority for moving from the pre-enrollment list into the waiver. The list is dynamic: your category can move up if circumstances deteriorate (caregiver illness, an aging caregiver with no alternate, behavioral safety concerns). Request a category review when your situation changes.

My adult child is on the iBudget waitlist. Should we opt into ICMC on July 1, 2026?

It depends on three things, (1) where you are in the iBudget category list, (2) whether the integrated managed-care model fits your family's needs, and (3) whether you'd lose access to a specific iBudget service (like a particular residential habilitation tier or a CDC+ self-direction arrangement) under FCC's plan. Talk to your support coordinator and FCC's enrollment line before opting in. Opting in removes you from the iBudget list.

Can a spouse be paid as a family caregiver in Florida?

Through SMMC LTC's Participant Direction Option (PDO), yes, including for personal care services. Through iBudget's CDC+, paid-spouse rules are narrower than under SMMC LTC PDO. Verify the current CDC+ Program Handbook for spouse-as-paid-worker conditions.

Are FHHA earnings going to disqualify my child from Medicaid?

AHCA has requested an income disregard from CMS so family caregiver earnings don't count against the child's Medicaid eligibility, but final approval is not confirmed as of mid-2026. Until the disregard is in effect, plan carefully: talk to a Medicaid planner or the FHHA-participating home health agency about how the agency structures the arrangement and whether a pooled trust is appropriate.

Can a Medicaid-only (non-dual) Floridian enroll in PACE?

Yes, but the member pays any applicable Medicaid share of cost under Personal Needs Allowance (PNA) rules. Most PACE participants are dual-eligible because that is where the financial integration delivers the largest benefit.

Why doesn't Florida have a 1915(i) state-plan option?

A 1915(i) option would convert HCBS to an entitlement and would substantially increase Florida's Medicaid spend. The state has chosen to keep HCBS slot-limited via 1915(c) waivers and the 1115 MMA demonstration. There is no current legislative proposal to add a 1915(i) option in Florida.

Why isn't Florida an MFP state?

Florida received a Money Follows the Person (MFP) grant in 2011 but withdrew in 2013 and has not re-participated, even though the federal program has since been extended. Nursing-home-to-community transitions in Florida happen within SMMC LTC and individual managed-care plans without a dedicated MFP budget.

What happened to the Project AIDS Care (PAC) waiver?

PAC was terminated December 1, 2017. The 2017 Florida Legislature amended state law so that AIDS-diagnosed individuals can obtain and maintain Medicaid without PAC enrollment. Former PAC participants moved to MMA.

What's the Model Waiver redesign and when does it take effect?

Florida has signaled it will redesign and broaden the Model Waiver, which would be the first significant change to it in many years. The scope and timeline are still being finalized, so if your family has a medically fragile child who doesn't currently meet Model Waiver criteria, ask AHCA whether the redesigned eligibility applies before assuming it does.

How is HB 1103 (2025) affecting iBudget transparency?

HB 1103 requires APD to post the iBudget pre-enrollment list at the county level every five days, plus quarterly reconciliation and foster-youth transition planning. Families can now see waitlist movement in their own county in near-real-time, and APD can no longer let the list go stale.

The bottom line

Florida's HCBS landscape is not one program; it is a portfolio. Three engines (SMMC LTC, iBudget, FHHA) plus ICMC, PACE, and two niche legacy waivers. Each pathway has its own eligibility test, its own waitlist dynamics, its own paid-family-caregiver rules, and its own application phone number.

The most important decisions in 2026:

  1. Apply early. iBudget non-crisis waits can run for years; the sooner you file, the sooner your eligibility-determination date starts working in your favor within your category.
  2. Watch the July 1, 2026 ICMC opening. If you have an adult on iBudget or LTC, evaluate ICMC carefully; it is a one-way door with a return option that has timing implications.
  3. For medically fragile children: stack pathways. FHHA (immediate paid family caregiver), the Model Waiver (especially if the planned redesign expands eligibility), and iBudget (if there is an IDD overlap) can run in parallel.
  4. For PACE-area dual-eligibles 55 and over: consider PACE. Florida has historically had unused PACE capacity. PACE delivers the most integrated care of any pathway in the state, at zero out-of-pocket cost for dual-eligibles.
  5. Don't rely on out-of-date sources. The PAC waiver is gone. LTCCDPP is gone. MFP isn't operating in Florida. 1915(i) doesn't exist here. If a guide tells you otherwise, it's stale.

Florida's HCBS portfolio is the most complicated in the country. It's also the most flexible, there are more pathways for paid family caregiving in Florida than in any peer state. If you can navigate the maze, you'll find a pathway that fits.

Need help navigating?

Florida's HCBS pathways are complicated by design. If you're staring at this guide trying to figure out where to start for a specific family member, here are the people to call.

For an older parent (65+) or physically disabled adult: Start with the DOEA Elder Helpline at 1-800-963-5337. They'll route you to your local Aging and Disability Resource Center (ADRC) and the SMMC LTC release-list process. See our full Florida Long-Term Care Waiver guide.

For a child or adult with IDD: Start with APD's iBudget customer line at 1-866-273-2273. Apply for the pre-enrollment list immediately even if you expect a long wait, your eligibility-determination date is what governs your position within your category.

For a medically fragile child on private duty nursing: Ask the child's home health agency about FHHA participation, and call AHCA's Medicaid Helpline at 1-877-254-1055 about Model Waiver eligibility.

For an adult 55 and over in a PACE service area: Use the Florida PACE Providers Association directory to find your local PACE organization, then call them directly to check current capacity.

For paid family caregiving: See our complete guide, How to Get Paid as a Family Caregiver in Florida.

For free legal help with appeals or eligibility denials: Florida Senior Legal Helpline 1-888-895-7873 (age 60+).

For advocacy and rights protection: Disability Rights Florida.

The pathway that fits your family is in this guide. If your circumstances qualify, applying early and applying to the right program are the two most consequential steps you can take.

Learn More

MedicaidFlorida Long-Term Care WaiverFlorida LTC waiver in 2026: how the 8-rank frailty waitlist works, the covered home and community-based services, hiring a spouse through PDO, and how to apply. MedicaidMedicaid HCBS Waivers by StateMedicaid HCBS waivers pay for care at home instead of a nursing facility. How 1915(c) waivers work, who qualifies, why waitlists happen, and your state's guide. MedicaidFlorida Medicaid Eligibility & Income LimitsFlorida Medicaid has six income limits, not one. The 2026 rules for ICP, the SMMC LTC waiver, MEDS-AD, Medically Needy, MSPs, and the Miller Trust workaround. MedicaidHow to Apply for Florida MedicaidHow to apply for Florida Medicaid: the six pathways, the three agencies (DCF, AHCA, DOEA), documents you need, processing timelines, and how to appeal a denial. MedicaidWhat Florida Medicaid CoversFlorida Medicaid covers doctors, hospitals, drugs (usually $0), dental, vision, hearing, and rides to care, across three managed-care plans in 2026. MedicaidFlorida Medicaid Programs OverviewHow Florida Medicaid works for seniors: SMMC 3.0 plans, eligibility, income limits, LTC waiver, estate recovery, and the three-agency application process. CaregiverHow to Get Paid as a Family Caregiver in FloridaSix Florida programs that pay family caregivers in 2026, including the rare Medicaid pathway that lets spouses be hired. Who qualifies and how to apply.

Find personalized help navigating Florida's HCBS waivers at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.