How to Get on a Florida Medicaid HCBS Waiver

Florida Medicaid HCBS waivers are not a single program but a set of separate pathways, each with its own eligibility test and its own front door. Florida's home and community-based services (HCBS) run through SMMC LTC for older adults and adults with disabilities, iBudget for people with developmental disabilities, a voluntary managed-care pilot (ICMC) for adults on the iBudget waitlist, PACE, two more waivers, and a state law that lets family caregivers of medically fragile children be paid as home health aides. Each one has its own waiting list (or lack of one) and its own paid-family-caregiver rules.

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 can mean waiting on the wrong list.

This guide is the map. We cover the main HCBS pathways in Florida for 2026, the eligibility rules behind each one, how each waitlist works, the paid-caregiver options inside each program, and a decision tree at the end so you can find your starting point quickly.

Florida Medicaid HCBS waivers compared: the main pathways side by side

Read this table sideways. Eligibility is age plus diagnosis plus level of care, not just income. A 15-year-old with autism cannot use SMMC LTC even if her family income qualifies: SMMC LTC starts at 18, and iBudget uses the ICF/IID level of care rather than the nursing-facility test. A 70-year-old with Down syndrome could meet the entry tests for both SMMC LTC and iBudget, and the two programs have different lists and different paid-caregiver rules.1,4

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

SMMC LTC: Florida's HCBS program for older adults and adults with disabilities

The Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program delivers Medicaid long-term care, including care at home, through managed care plans that contract with the Florida Agency for Health Care Administration (AHCA). Medicaid recipients who qualify and enroll receive their long-term care services from a long-term care managed care plan.6 To be eligible, a person must be a Medicaid recipient age 65 or older, or age 18 or older and eligible for Medicaid by reason of a disability, and be found by the CARES preadmission screening program to need nursing facility care (or hospital level of care, for people diagnosed with cystic fibrosis). The Florida Department of Elder Affairs (DOEA) keeps the program's statewide list.1

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

• Medical (level-of-care) eligibility: Nursing facility level of care, determined by DOEA's CARES (Comprehensive Assessment and Review for Long-Term Care Services) program. A CARES registered nurse or assessor completes the assessment at no cost to the applicant and recommends the least restrictive, most appropriate placement.7 The program description adds that the person must meet one or more established clinical criteria.6
• Financial eligibility: In 2026, Florida's income cap for HCBS waiver programs is $2,982 a month (300% of the $994 Supplemental Security Income (SSI) federal benefit rate), and an individual's countable resources cannot exceed $2,000 ($5,000 if income is within the MEDS-AD limit). Income above the cap may still qualify through a qualified income trust, often called a Miller trust.5 Financial eligibility is decided by the Department of Children and Families or the Social Security Administration, separately from the CARES medical determination.7
• Waitlist: SMMC LTC is not an open entitlement: enrollment offers are made only when funds are available. DOEA keeps a statewide pre-enrollment list (the state rule still calls it the wait list), and a priority score from the aging and disability resource center (ADRC) screening sets the order of release. When people have identical scores, the one placed on the list earliest goes first. A low priority rank (Ranks 1 and 2, scores 0 to 29) means you are not placed on the list at all, but you can ask the ADRC for a rescreening after a significant change.1
• Two 30-day deadlines: If DOEA can't reach you to schedule a screening or rescreening, you must contact DOEA within 30 calendar days of its notice or be dropped from the screening process and the list. After release, the Medical Certification for Medicaid Long-term Care Services and Patient Transfer Form (AHCA MedServ 5000-3008) must be returned to DOEA within 30 calendar days. Release is a chance to finish enrolling, not enrollment itself.1
• Skipping the list: Florida law gives priority enrollment, with no screening or list, to three groups, including a nursing facility resident who asks to move back to the community and has lived in a Florida-licensed skilled nursing facility for at least 60 consecutive days.1
• Paid family caregiver: Yes, through the Participant Direction Option (PDO). A member living in their own home or a family home who has adult companion care, attendant nursing care, homemaker services, intermittent and skilled nursing, or personal care on their plan of care can hire their own worker, "including but not limited to neighbors, family members, or friends," and the plan may not require a worker from its own network. In-home respite is not a PDO service in either the July 2026 plan contract or Florida's current 1915(c) LTC waiver. That waiver (approved effective April 1, 2025) also lets a member select a legally responsible person, such as a spouse, to provide PDO services if that person is 18 or older, passes a Level II background screening, signs a worker agreement, and meets the plan contract's minimum provider qualifications. The July 2026 plan contract states the family-hiring rule without naming spouses. The representative who holds employer authority for the member can't also be the paid worker.2,8 See our Florida Long-Term Care Waiver guide for how to enroll.
• What it covers: Every LTC plan must cover, at a minimum, a 26-service array that includes adult companion, adult day health care, assisted living facility services, attendant care, home accessibility adaptation, home-delivered meals, homemaker, hospice, intermittent and skilled nursing, personal care, a personal emergency response system, and respite care. That list is a floor, so a plan may cover more, but each service is provided based on medical necessity or because it is needed to delay or prevent nursing facility placement.6

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 name of the Home and Community-Based Services (HCBS) waiver run by the Florida Agency for Persons with Disabilities (APD) under Florida Statutes section 393.0662, serving people with developmental disabilities.4

iBudget is not an entitlement: by statute, a client's annual waiver spending may not exceed his or her iBudget, and the total of all clients' projected annual iBudget expenditures may not exceed APD's appropriation for waiver services.4 Because the waiver covers a limited number of people, APD keeps a pre-enrollment list, what most families call the "waitlist", and as of March 20, 2026, 16,362 individuals were on it. As people leave the program or new funding becomes available, APD enrolls people from that list in a statutory order of priority across seven categories, set by Florida Statutes section 393.065(5). Your category comes first. Within Categories 3 through 7, the statute then puts people in order of the date each was determined eligible for waiver services.3 The count moves: state law requires APD to post the number of people in each priority category by county on its website and to update it at least every 5 days, so check APD's current figure before relying on any count.3

Who qualifies for iBudget

Three eligibility tests must all be cleared:

1. Diagnostic. The applicant must have a developmental disability as Florida Statutes section 393.063 defines it: a disorder or syndrome attributable to intellectual disability, cerebral palsy, autism, spina bifida, Down syndrome, Phelan-McDermid syndrome, Prader-Willi syndrome, or Tatton-Brown-Rahman syndrome, that manifests before age 18 and constitutes a substantial handicap that can reasonably be expected to continue indefinitely.4
2. Level of care. The applicant must meet the federal ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities) level-of-care requirement. This is not the same as the nursing-facility level of care used for SMMC LTC.4
3. Financial. In 2026, Florida's HCBS waiver income cap is $2,982 a month (300% of the SSI federal benefit rate) and the countable-resource limit is $2,000 for an individual ($5,000 if income is within the MEDS-AD limit); Florida's eligibility manual lists iBudget Florida as an HCBS waiver program.5 The Florida Department of Children and Families (DCF) or the Social Security Administration decides financial eligibility.7

Important: Meeting all three tests does not get you services by itself. Because total spending is capped at the appropriation, an applicant who meets the ICF/IID level of care is assigned to a pre-enrollment category and waits for funding to reach that category.4

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:4,3

Your category is not fixed. A parent-caregiver turning 60, a caregiver's new diagnosis, an approaching discharge from a nursing facility, or an approaching high school graduation can each bear on which category applies, and a change in circumstance is what APD asks people on the list to report.3

If you are already on the pre-enrollment list and your circumstances change, or you need services right away, APD's instruction is to contact your local APD regional office, ask to speak to your assigned worker; you can also print the Annual Status Review form.3

How the iBudget allocation works

Once a slot is offered, the amount is not flat. Each person's iBudget is set by the allocation methodology defined in Florida Statutes section 393.063(4), used together with an assessment instrument APD deems reliable and valid, including its Questionnaire for Situational Information (QSI). The person's annual waiver spending may not exceed that iBudget.4

Allocations differ from person to person, so confirm the budget that applies to your family member with APD rather than relying on an average.

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. Ask APD how iBudget's rules apply to your family before assuming a relative can be hired. For Florida's paid-caregiver routes across programs, including the SMMC LTC PDO and the paid family aide route for medically fragile children, see How to Get Paid as a Family Caregiver in Florida.

How funding moves the waitlist

Because the waiver covers only as many people as each year's appropriation pays for, the list moves with the budget. Per the Florida House of Representatives' final bill analysis of CS/HB 565 (2026), reporting figures APD supplied, the Legislature appropriated a total of $256,102,620 in additional recurring funds from 2017 through 2024 to enroll people from the pre-enrollment list, and the average cost per client per year on the iBudget waiver is $58,000.3 Because the dollar amounts change every budget cycle, check the current year's figures before relying on them.

ICMC: the voluntary managed-care pilot for adults on the iBudget list

The Intellectual & Developmental Disabilities Comprehensive Managed Care (ICMC) program is the name AHCA's enrollment broker uses for the pilot program for individuals with developmental disabilities under Florida Statutes section 409.9855.9 The pilot provides coverage of comprehensive services using a managed care model.3

Who can join. Effective October 1, 2025, and regardless of region, an individual may enroll who is Medicaid eligible, is 18 or older, has a developmental disability as defined in s. 393.063, and is placed in any iBudget pre-enrollment category.3

It is voluntary. Participation is voluntary and limited to the number of enrollees set in the General Appropriations Act, and you must make an affirmative choice before any enrollment action.3 The state may not enroll you automatically.9

Getting back out. An enrollee who declares an intent to leave voluntarily must be given the chance to enroll in any appropriate existing Medicaid waiver program if he or she has been covered by the pilot for the entire previous plan year, if the agency finds a good-cause reason to disenroll, or if the pilot stops operating.3 So in the first plan year, the guaranteed route back to a waiver runs through a good-cause finding or the pilot ending.

If you're on the iBudget pre-enrollment list right now, the question is: does the pilot give my family services sooner than waiting for an iBudget slot? Talk with APD and AHCA's enrollment broker at 1-877-711-3662 before opting in.9

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

The Program of All-Inclusive Care for the Elderly (PACE) is a federal model defined in Medicaid law at 42 U.S.C. 1396u-4 and governed by 42 CFR Part 460.4,10 The PACE organization is paid a fixed monthly capitation amount for each participant: by Medicare for its Medicare participants, and by the state for its Medicaid participants, which the organization must accept as payment in full.10

PACE eligibility

• Age 55 or older.4
• Needs nursing-facility level of care, as determined under the State Medicaid plan.
• Lives in a PACE service area. PACE coverage is geographic.10
• Able to live in a community setting without jeopardizing health or safety, at the time of enrollment.10

You do not have to be on Medicare or Medicaid already: federal rules say a potential enrollee may be, but is not required to be, entitled to Medicare Part A, enrolled in Part B, or eligible for Medicaid.10 Ask the PACE organization what you would pay given your own coverage.

Finding a Florida PACE organization in 2026

Florida has several PACE organizations, but coverage is local and the roster changes as organizations add sites and service areas. Do not assume a provider near you exists or has open slots without checking the current CMS or AHCA PACE list.10

The Florida PACE Providers Association directory is another place to look for your local organization before applying.

Paid family aides for medically fragile children

Florida's home health aide program for medically fragile children rests on section 400.4765 of the Florida Statutes (last amended in 2025), which lets a home health agency employ a family caregiver as a home health aide for a medically fragile child.4

Who can be the paid aide

The aide must be 18 or older, a family caregiver of an eligible relative, and meet the statute's other requirements. The aide's services must reduce the child's private duty nursing (PDN) hours and may not be provided at the same time as any PDN service.4 Ask the child's home health agency whether your child is eligible.

What the program changes

A parent or other relative who already gives the child hands-on care can be employed by a home health agency and paid for the aide services they deliver, instead of caring unpaid.4

The training and supervision model

• At least 76 hours of approved training, including at least 40 hours of home health aide training, at least 20 hours of skills training on basic nursing skills tailored to the child's plan of care, and at least 16 hours of clinical training under the direct supervision of a licensed registered nurse.4
• A registered nurse validates competency. The employing home health agency must provide that validation.4

The utilization caps and pay rate

The Medicaid fee schedule for home health agencies employing these aides sets a minimum rate of $25 per hour and a cap of 12 hours per day and 40 hours per week per medically fragile child. The weekly cap can be exceeded only with justification of why no other qualified provider is available, approved by both the home health agency and the managed care plan.4 The $25 is what Medicaid pays the agency, so ask the agency what it pays the aide.

Before you start, ask the agency how the aide's earnings could affect your household's Medicaid eligibility.

Two more waivers: Model Waiver and Familial Dysautonomia (FD) Waiver

Florida's Medicaid eligibility rule names two more waivers alongside its main HCBS waiver programs: the Model Waiver (Katie Beckett) and the Familial Dysautonomia (FD) Waiver.5

If your family member may fit either one, ask AHCA, which administers Florida Medicaid, about eligibility and openings before applying.7

Money Follows the Person and moving home from a nursing facility

Money Follows the Person (MFP) is a federal Medicaid demonstration under which CMS awards funding to states to move people living in institutions, such as nursing facilities, into community-based settings.11 Florida received an MFP grant award in 2011 and withdrew from the program in 2013.4 If a guide points you to Florida's MFP program, check its date.

Another route runs through SMMC LTC itself: a nursing facility resident who asks to move back to the community and has lived in a Florida-licensed skilled nursing facility for at least 60 consecutive days can enroll with priority, without the screening and wait-list process.1

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 a developmental disability → Apply for iBudget as early as possible; 16,362 people were on the pre-enrollment list as of March 20, 2026, and within Categories 3 through 7 the date you were determined eligible sets your place. Tell APD when circumstances change, since Category 1 (crisis) gets first priority.3

Under 21, medically fragile, on Private Duty Nursing → Ask the child's home health agency about the paid family aide program, where a family caregiver 18 or older can be employed as the child's paid aide, and ask AHCA about the Model Waiver. If the child also has a developmental disability, apply for iBudget in parallel.

Adult 18+ with a developmental disability → iBudget is your primary engine. If you're in any iBudget pre-enrollment category, the voluntary ICMC pilot is open to you now.

Adult 55 to 64 in a PACE service area, needing nursing-facility level of care → Consider PACE, and check with the local PACE organization about openings.

Adult 18+ eligible for Medicaid by reason of a physical disability → SMMC LTC.

Adult 65+ with frailty, ADL deficits, or cognitive decline → SMMC LTC. Add PACE to the consideration set if you live in a service area.

Confirmed Familial Dysautonomia diagnosis → Ask AHCA about the FD Waiver.

Rules that trip families up

• ICMC is voluntary, but leaving is limited. The guaranteed route back to an existing waiver depends on a full previous plan year in the pilot, a good-cause finding, or the pilot ending.3
• A low SMMC LTC rank keeps you off the list. Ranks 1 and 2 are not placed on the wait list; ask for a rescreening when your situation changes.1
• Paid family aide hours replace nursing hours. The aide's services must reduce the child's private duty nursing hours and can't run at the same time as PDN.4

Application resources: phone numbers and websites

Save these. You'll use most of them.

The bottom line

Florida's HCBS system is not one program; it is a set of them: SMMC LTC, iBudget, the ICMC pilot, PACE, the paid family aide program for medically fragile children, and two more waivers. Each pathway has its own eligibility test, its own waitlist rules, and its own paid-family-caregiver rules.

The most important decisions in 2026:

1. Get on the right list early. The iBudget list is ordered by category first and, within Categories 3 through 7, by the date APD determined each person eligible, so getting a determination early and keeping APD told about changes both help. The SMMC LTC list is ordered by priority score, with the earliest placement date breaking ties.3,1
2. Weigh the ICMC pilot carefully. It is voluntary, but the guaranteed way back to a waiver depends on a full plan year, a good-cause finding, or the pilot ending.
3. For medically fragile children: ask about each door. The paid family aide program (capped at 12 hours a day and 40 a week), the Model Waiver, and iBudget (if there is a developmental disability) are separate pathways.
4. For people 55 and over in a PACE service area: consider PACE. You don't need Medicare or Medicaid already to enroll.
5. Check the dates on what you read. Florida withdrew from MFP in 2013, and the iBudget waitlist count changes, so an old guide can be wrong about both.

Florida's HCBS system is complicated, but it has more than one route to paying a family caregiver, including the PDO in SMMC LTC and the paid family aide program for medically fragile children. If you can work through it, you'll find a pathway that fits.

Need help choosing?

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, which reaches your local Aging and Disability Resource Center (ADRC).7 See our full Florida Long-Term Care Waiver guide.

For a child or adult with IDD: Start with APD to apply for iBudget. Get on the pre-enrollment list even if you expect a long wait, then tell your local APD regional office whenever your circumstances change, because your category comes first, and within Categories 3 through 7 the date you were determined eligible sets the order.3

For a medically fragile child on private duty nursing: Ask the child's home health agency about the paid family aide program, and ask AHCA 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 an SMMC LTC wait-list decision: DOEA's written notice must include instructions for requesting a fair hearing.1

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

Find personalized help with 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.