Florida LTC Waiver: Waitlist & Services (2026)

The Florida LTC waiver decides who gets in by frailty, not by who applied first. The program is the Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) waiver, Florida's path to Medicaid-funded help at home, in an assisted living facility, or in an adult family care home instead of a nursing home, and a daughter trying to get care for her mother learns quickly that time on the list does not move her forward.

Unlike a Medicaid benefit you qualify for and start using, the SMMC LTC waiver is not an entitlement. Florida funds a fixed number of legislatively set enrollment slots, and when those slots are full, applicants go onto an active, frailty-ranked wait list. You do not climb that list by waiting; you move up because of how frail you are.

This guide walks through who qualifies, how the 8-rank priority system actually works, what the waiver pays for, the Participant-Directed Option that lets you hire your own caregiver (including a spouse), and the three-agency application path you will need to navigate.

In This Guide

• Key Takeaways
• What the Florida LTC Waiver Is, and Isn't
• The Three Eligibility Tests
• How the Florida LTC Waiver Waitlist Works: 8 Priority Ranks
• How to Apply: Elder Helpline to CARES to AHCA
• What the Florida LTC Waiver Covers
• The Participant-Directed Option: Hire Your Own Caregiver
• The LTC Plans: Statewide vs. Regional
• What If You're Stuck on the Waitlist?
• Frequently Asked Questions
• Learn More

What the Florida LTC Waiver Is, and Isn't

The SMMC LTC waiver is the long-term services and supports component of Statewide Medicaid Managed Care (SMMC), Florida's statewide Medicaid managed-care program. SMMC has three tracks: the Managed Medical Assistance (MMA) program for acute and primary care, the Long-Term Care (LTC) program, and a statewide prepaid dental program. The current iteration, SMMC 3.0, launched on February 1, 2025 under contracts that run through 2030.5

Federally, the program runs under a combined Section 1915(b) and Section 1915(c) waiver. The 1915(b) authority lets Florida deliver Medicaid through managed-care plans rather than fee-for-service, and the 1915(c) home and community-based services (HCBS) authority lets the state cover services beyond what regular state-plan Medicaid covers. That combination is the legal reason the LTC waiver can be capped while still being lawful Medicaid.1

The federal Medicaid statute treats nursing-facility care as an entitlement but lets a state cap home and community-based care. Florida caps it. That structural difference is the single most important thing to understand about the program: the same medical and financial situation can mean approved today if your loved one is in a nursing home and a long wait if they are at home.

The program is run by the Florida Agency for Health Care Administration (AHCA), the single state Medicaid agency, with two other agencies playing critical roles: the Department of Elder Affairs (DOEA) determines functional eligibility through its CARES program, and the Department of Children and Families (DCF) determines financial eligibility through ACCESS Florida.6

The Three Eligibility Tests

To enroll in the SMMC LTC waiver, you have to clear three independent gates. Failing any one of them blocks the others.

Test 1: Age and Disability

The waiver serves adults age 65 or older, and adults age 18 or older with a disability that meets the Social Security disability standard. Florida residents under 18 with disabilities, and adults under 65 with intellectual or developmental disabilities, are generally served through other Medicaid pathways such as the Florida iBudget Waiver rather than SMMC LTC.1

Test 2: Nursing Facility Level of Care via CARES

Functional eligibility is determined by the Department of Elder Affairs' Comprehensive Assessment and Review for Long-Term Care Services (CARES) program. CARES determines medical eligibility (Nursing Facility Level of Care) for Medicaid long-term care, is staffed by registered nurses, physicians, and trained assessors, and completes its assessment at no cost to the applicant.6

CARES uses a two-step process. A short-form telephonic screening, conducted by your Area Agency on Aging at intake, generates the priority score that sets your waitlist rank. A comprehensive face-to-face assessment, conducted by a CARES nurse after a slot opens, evaluates Activities of Daily Living (bathing, dressing, toileting, transferring, continence, eating), cognition, medical complexity, caregiver availability, and home safety. A CARES physician or registered nurse then issues the formal Nursing Facility Level of Care determination. For applicants already in a Florida-licensed nursing facility, that assessment happens without waiting for a slot.

Test 3: Financial Eligibility through DCF and ACCESS Florida

Financial eligibility uses the same SSI-related rules as the Institutional Care Program:2

• Single applicant income: $2,982 per month in 2026 (300% of the federal Supplemental Security Income Federal Benefit Rate of $994).2
• Countable assets: $2,000 for an individual.2
• Married, one spouse applying: the applicant's income only is counted, the applicant's assets are capped at $2,000, and the non-applicant community spouse is protected by the Community Spouse Resource Allowance (CSRA) of up to $162,660 in 2026 (the federal maximum).2
• Home equity exemption: $752,000 in 2026 (the lower federal tier Florida applies); the primary residence is otherwise exempt as a countable asset when the applicant intends to return, a community spouse lives there, or a dependent relative lives there.2

Florida is an income-cap state for long-term care. If your gross monthly income exceeds $2,982, you cannot qualify for the LTC waiver no matter how high your medical expenses are, unless you establish a Qualified Income Trust (also called a Miller Trust). The trust receives the income above the cap each month and routes it to allowable expenses, and it must be funded before eligibility begins and name Florida as residual beneficiary. There is no retroactive Qualified Income Trust.2

How the Florida LTC Waiver Waitlist Works: 8 Priority Ranks

This is the section that matters most to families, because it explains why two people who applied on the same day can wait very different lengths of time, and what you can do about it. Watching a parent struggle at home month after month while the list seems frozen is its own kind of strain; understanding how release actually works is the first thing that gives a family any leverage over the wait.

By statute, the Department of Elder Affairs maintains a statewide wait list for the long-term care program, and a priority score sets the order for releasing people from the list, which means release is driven by assessed frailty, not by how long an applicant has waited. The priority system is established in Florida Statute 409.979 and operationalized in Fla. Admin. Code R. 59G-4.193, which sets 8 ranks.1

A few things families should know about how this works in practice:

• Ranks 1 and 2 are not on the active wait list. If your loved one screened into Rank 1 or 2, they are notified that they do not currently meet the criteria. They are not waiting and they are not on the list. Families often call back months later expecting to check the list, only to learn they were never on it.1
• Rank 8 is the fastest path. Adult Protective Services High Risk Referrals are the highest priority for release. APS investigations are triggered by reports of abuse, neglect, exploitation, or self-neglect to the Florida Abuse Hotline at 1-800-962-2873. Self-neglect, an older adult who cannot safely care for themselves and lacks adequate support, is a legitimate basis for a referral.7
• Re-screening is your friend. If your loved one's situation worsens after the initial screening, such as a fall, a hospital admission, or the loss of a primary caregiver, call your Area Agency on Aging back and request a re-screen. A new score may move them to a higher rank.

How to Apply: Elder Helpline to CARES to AHCA

Because three agencies are involved and the application has both functional and financial sides, the path can feel labyrinthine. The cleanest order of operations:6

What the Florida LTC Waiver Covers

The SMMC LTC waiver covers a defined catalog of home and community-based services, authorized under Florida's Section 1915(b) and 1915(c) waiver and operationalized at Fla. Admin. Code R. 59G-4.192. The covered array includes Adult Companion, Adult Day Health Care, Assistive Care Services, Assisted Living Facility Services, Attendant Care, Caregiver Training, Case Management, Home Accessibility Adaptation, Home-Delivered Meals, Homemaker, Hospice, Intermittent and Skilled Nursing, Medical Equipment and Supplies, Medication Administration and Management, Nutritional Assessment, Occupational, Physical, Respiratory, and Speech Therapy, Personal Care, Personal Emergency Response System, Respite Care, and Transportation. These services are available based on medical necessity, or where they are necessary to delay or prevent nursing facility placement.3

The waiver also funds a one-time community-transition benefit for members moving from a nursing facility back to the community, covering the practical costs of getting set up. Members who have lived in a Florida-licensed nursing facility for 60 or more consecutive days and want to return to the community get priority placement on the wait list.1

Services in the LTC Waiver That Regular Medicaid Does Not Cover

A common question is why bother with the wait list at all, when a parent could enroll in regular Medicaid. The answer is that several of the most useful services are only available through the LTC waiver, not through regular Managed Medical Assistance: home accessibility adaptations such as ramps and grab bars, home-delivered meals, adult companion care, homemaker services, a personal emergency response system, adult day health care, and assisted living and adult family care home services. Regular Medicaid covers doctor visits, prescriptions, and hospital stays; the LTC waiver covers the services that let an older adult actually stay at home.3

The Assisted Living and Adult Family Care Home Distinction

Florida has two distinct license categories for residential personal-care settings, and the waiver covers both. For a member living in an assisted living facility or an adult family care home, the waiver pays for personal care and supportive services but not room and board, which the member pays from personal income.3

An adult family care home is a smaller, more home-like setting limited to a handful of residents, with the licensed provider living on-site, while an assisted living facility is a larger licensed setting.

The Participant-Directed Option: Hire Your Own Caregiver

For many families, the most useful feature of the SMMC LTC waiver is the Participant-Directed Option (PDO), the consumer-direction track that lets an enrolled, community-dwelling member directly hire, train, schedule, and supervise their own caregiver. PDO is not available while residing in an assisted living facility, an adult family care home, or a nursing facility.4

Which Services Are PDO-Eligible, and Who Can Be Hired

Under the current SMMC LTC contract, the services that can be delivered through PDO are Adult Companion Care, Attendant Nursing Care, Homemaker Services, Personal Care, and Intermittent and Skilled Nursing. Other services, such as in-home respite, adult day health care, transportation, and durable medical equipment, are delivered by the LTC plan's contracted network providers.4

This is where Florida's PDO differs from many other states: a member may hire a family member, and in Florida that includes a spouse. The federal authority is the home and community-based services waiver power: under Section 1915(c) a state may pay for HCBS under a written plan of care, and Section 1915(j) lets a state pay for self-directed personal assistance services. That authority overrides the state-plan personal-care rule at 42 CFR Section 440.167, which otherwise bars paying a legally responsible relative for state-plan personal care. A separate Centers for Medicare and Medicaid Services "extraordinary care" standard limits paid family members to care beyond what they would ordinarily furnish without compensation.4

A few restrictions are worth keeping in mind:

• Hiring a spouse can, in some cases, increase a couple's countable income for Medicaid eligibility, so couples should review the decision with a Medicaid planner or elder-law attorney before electing it.
• A person serving as the member's PDO Representative cannot simultaneously be the paid Direct Service Worker for that member.
• A paid PDO worker cannot also receive Caregiver Training service hours, which are reserved for unpaid informal caregivers.

Worker Requirements and EVV

Every PDO Direct Service Worker must be at least 18 years old, be authorized to work in the United States, pass a Level 2 (AHCA, FDLE, and FBI fingerprint-based) background screening under Chapter 435 of the Florida Statutes, and sign a written PDO Direct Service Worker Agreement. The member is the common-law employer, while a Fiscal/Employer Agent assigned by the LTC plan handles payroll and tax withholding.4

Federal Electronic Visit Verification (EVV) applies to PDO personal-care and home-health hours under the 21st Century Cures Act. Workers clock in and out through the Fiscal/Employer Agent's mobile app, phone system, or web portal, which captures the worker's identity, the member's identity, the date, the start and end times, the service type, and the location. No EVV record means no pay.4

To start PDO, ask your LTC plan's care manager. The care manager confirms eligibility, assigns the Fiscal/Employer Agent, processes your worker's background screening, sets up payroll, and trains you on EVV.

The LTC Plans: Statewide vs. Regional

Florida combined its former regions into 9 lettered regions, A through I, effective with SMMC 3.0 on February 1, 2025, and Florida statute requires at least two LTC plan choices in every region. Several plans hold a statewide long-term care footprint, while others operate in select regions only.8

Statewide long-term care plans (all 9 regions, A through I):

• Humana Medical Plan
• Sunshine State Health Plan (Centene)
• Simply Healthcare Plans (Elevance/Anthem)
• Florida Community Care (an LTC-focused plan covering all 9 regions in two contract configurations)

Regional long-term care plans (select regions):

• Aetna Better Health of Florida (Regions D, E, and I)
• UnitedHealthcare of Florida (Regions B, D, and I)
• Molina Healthcare of Florida (Region I)

AmeriHealth Caritas Florida exited Florida SMMC effective February 1, 2025 and is no longer an active SMMC plan; older sources listing it as an LTC choice are obsolete. To confirm the plans in your region, call the choice-counseling line at 1-877-711-3662 or visit flmedicaidmanagedcare.com, which is the authoritative source for plan availability by ZIP code.8

What If You're Stuck on the Waitlist?

A common situation: a family applies, screens into Rank 4, and is told it could be many months before a slot opens, while a parent is still struggling at home. A few things may help in the gap:

• Community Care for the Elderly (CCE), a state-funded program under Sections 430.201 through 430.209 of the Florida Statutes, delivers home and community-based services through the Area Agencies on Aging to functionally impaired elders at risk of nursing-facility placement, including those on the LTC waiver wait list. It operates on a sliding-fee basis.7
• Older Americans Act services through your Area Agency on Aging, such as home-delivered meals, transportation, and caregiver respite, are available regardless of waitlist status. Call the Elder Helpline at 1-800-963-5337.7
• Re-screening when status changes. If your loved one falls, is hospitalized, loses a primary caregiver, or shows new cognitive decline, call your Area Agency on Aging for a re-screen; the new score may shift them to a higher rank.
• An Adult Protective Services referral when appropriate. If self-neglect or caregiver abandonment is genuinely at issue, calling the Florida Abuse Hotline at 1-800-962-2873 triggers an investigation, and these High Risk Referrals are the fastest path off the wait list. This is a legitimate use of the hotline, not a workaround.7

Learn More

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.