Florida SMMC Long-Term Care Waiver: Waitlist & Services (2026)

When a Florida family needs Medicaid to pay for care at home instead of in a nursing facility, the program they're looking for is Florida's SMMC Long-Term Care (LTC) waiver. It's the answer for a mother who needs help bathing and dressing, a father at risk of a fall, or a spouse who can't be left alone safely while you're at work.

It is also the program that catches the most Florida families off guard. Because unlike a "regular" Medicaid benefit you qualify for and start using, the SMMC LTC waiver is not an entitlement. Florida funds a fixed number of slots each year, the program is full, and there is a waitlist of roughly 48,000–59,000 people. You don't move up that list by waiting; you move up because of how frail you are.

This guide is the operational reference. It walks through who qualifies, how the 8-rank priority system actually works, the full catalog of 21 services the waiver pays for, the Participant-Directed Option that lets you hire your own caregiver (including your spouse, a Florida specialty), and the three-agency application path you'll need to navigate.

What the SMMC LTC Waiver Is, and Isn't

The SMMC LTC waiver is the long-term services and supports (LTSS) component of Statewide Medicaid Managed Care (SMMC), Florida's statewide Medicaid managed-care program. SMMC has three components: Managed Medical Assistance (MMA, the acute-care side), the Long-Term Care waiver, and a separate statewide dental program. The current iteration, SMMC 3.0, launched on February 1, 2025 under contracts that run through 2030.

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

The federal Medicaid statute treats institutional care as an entitlement but treats home and community-based care as something a state can cap. 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 "wait 18 months" if they're at home.

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

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, or
• Adults age 18 or older with a disability that meets Social Security's disability standard.

Florida residents under 18 with disabilities are served through other Medicaid pathways (the Children's Medical Services Plan, the iBudget developmental-disability waiver, and others). Adults under 65 with intellectual or developmental disabilities are typically served through the iBudget waiver, not SMMC LTC.

Test 2: Nursing Facility Level of Care (NHLOC) via CARES

Functional eligibility is determined by DOEA's Comprehensive Assessment and Review for Long-Term Care Services (CARES) program. CARES has 17 field offices statewide and is staffed by registered nurses, physicians, and trained assessors.

CARES uses a two-step process:

1. 701S Short-Form Telephonic Screening. Conducted by your Area Agency on Aging at intake. The 701S generates a priority score, the number that determines your waitlist rank.
2. 701B Comprehensive Assessment. A face-to-face assessment conducted by a CARES nurse in your home, hospital room, or nursing facility after a slot opens. The 701B evaluates Activities of Daily Living (bathing, dressing, toileting, transferring, continence, eating), Instrumental ADLs (medication management, meal preparation, finances, transportation), cognitive function, behavioral status, medical complexity, caregiver availability, and home safety. A CARES physician or RN then issues the formal NHLOC determination.

For applicants already living in a Florida-licensed nursing facility for 60+ consecutive days (the ICP path), the 701B happens immediately, there's no wait. For everyone else, the 701B happens only after DOEA releases a slot.

Test 3: Financial Eligibility through DCF / ACCESS Florida

Financial eligibility uses the same rules as the Institutional Care Program:

• Single applicant income: $2,982/month (300% of the federal SSI Federal Benefit Rate).
• Countable assets: $2,000 for an individual.
• Married, both applying: $5,964/month combined income; $3,000 combined assets.
• Married, one applying: Applicant's income only counts; applicant's assets capped at $2,000; non-applicant "community spouse" protected by the Community Spouse Resource Allowance (CSRA) of up to $162,660 in 2026 (federal maximum) and the Minimum Monthly Maintenance Needs Allowance (MMMNA) of $2,643.75–$4,066.50/month (effective 7/1/2025–6/30/2026).
• Home equity exemption: $752,000 (federal cap).
• Five-year look-back: Any uncompensated transfer of assets in the 60 months before application triggers a transfer penalty.

Florida is an income-cap state. If your gross monthly income exceeds $2,982, you cannot qualify for the LTC waiver at all, no matter how high your medical expenses are, unless you establish a Qualified Income Trust (Miller Trust). The QIT receives the monthly income above the cap and routes it to allowable expenses each month (personal needs allowance, MMMNA payment to a community spouse, health-insurance premiums, patient responsibility share). The QIT must be funded before eligibility begins. There is no retroactive QIT.

The 8-Rank Waitlist: How Florida Releases Slots

This is the section that matters most to families because it explains why two people who applied on the same day can have wildly different waiting times, and what you can do about it.

The priority system is established in Florida Statute 409.979(3) and operationalized in Fla. Admin. Code R. 59G-4.193. The 701S short-form screening produces a priority score; the score maps to one of 8 ranks; DOEA releases slots monthly based on rank, not based on when you applied.

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

• Ranks 1 and 2 are not on the active waitlist. If your loved one screened into Rank 1 or 2, they're notified that they don't currently meet the criteria. They aren't waiting, they aren't on the list. This is a common source of confusion: families call back six months later expecting to "check the list" and discover they were never on it.
• Rank 8 is the fastest path. APS High Risk Referrals can move from screening to enrollment in days or weeks rather than months. 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 an APS referral.
• Re-screening is your friend. If your loved one's situation deteriorates after the initial 701S, a fall, a hospital admission, the death or illness of a primary caregiver, call the AAA back and request a re-screen. The new score may move them to a higher rank.
• Region matters. Slot release rates vary by SMMC region based on funded slot allocations and turnover. Counties with more retirees and slower slot turnover may have longer waits.

The active waitlist count has ranged from approximately 48,000 to 59,000 people over 2023–2024. The number fluctuates monthly. If you need a precise current count for an application or appeal, request the most recent monthly report from your AAA.

The On-Ramp: Elder Helpline → AAA → DOEA → CARES → AHCA

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

1. Call the Elder Helpline at 1-800-963-5337 (1-800-96-ELDER). The Helpline is operated by DOEA and the Area Agencies on Aging; it routes you to your county-specific AAA/ADRC.
2. The AAA conducts the 701S, typically a 30–60 minute phone call covering basic ADLs, IADLs, cognition, caregiver availability, and clinical history. The AAA generates your priority score and tells you your waitlist rank on the spot.
3. In parallel, file the financial application through ACCESS Florida at myaccess.myflfamilies.com. Standard processing takes 45 days; LTC applications can take up to 90 days. You want the financial determination on file before a slot opens so that the moment DOEA releases your loved one, services can start.
4. When DOEA releases a slot, the AAA refers your case to CARES for the formal 701B Comprehensive Assessment. A CARES nurse comes to the home (or hospital room or nursing facility) and conducts the face-to-face evaluation. A CARES physician or RN then issues the NHLOC determination, usually within a week or two of the assessment.
5. AHCA receives the approval and sends you to the enrollment broker at 1-877-711-3662 or flmedicaidmanagedcare.com. You choose an LTC plan from those operating in your region. If you don't choose within 30 or 60 days, AHCA auto-assigns. After enrollment you have a 120-day open change period.
6. The LTC plan's care manager contacts you within a few days to schedule an initial home visit, develop a Plan of Care, and authorize services. Per AHCA's Exhibit II-B contract specifications, this initial care planning typically happens within the first 7–10 business days of enrollment.

The entire timeline from initial Helpline call to first authorized service typically runs 45 to 90 days for top-priority applicants (Ranks 7–8) and months to multiple years for standard frailty ranks (3–5).

What the Waiver Actually Pays For: 21 Service Categories

The SMMC LTC waiver covers 21 service categories under §1915(b)(c), codified operationally in Fla. Admin. Code R. 59G-4.192 and in the AHCA-Plan model contract Exhibit II-B (LTC Program). The full catalog:

Beyond the recurring service array, the waiver also funds a one-time Community Transition benefit (historically capped at $5,000) for members moving from a nursing facility back to the community. The benefit pays for the practical costs of getting set up, security deposits, basic furniture, household goods, and minor home modifications. Members who have lived in a Florida-licensed nursing facility for 60+ consecutive days and want to transition back to the community get priority placement on the LTC waiver wait list.

Services in the LTC Waiver That Are NOT in Regular Medicaid

A frequently-asked question: "Why bother with the waitlist? Can't my mom just enroll in regular Medicaid and get this care?" The answer is that several of the most important services are only available through the LTC waiver, not through regular MMA Medicaid:

• Home accessibility adaptation (ramps, grab bars, etc.)
• Home-delivered meals
• Adult companion care
• Homemaker services
• Personal Emergency Response System (PERS)
• Adult day health care
• Assisted living facility services
• Adult family care home services
• Assistive care services

This is why families navigate the waitlist instead of just relying on MMA. MMA covers the doctor visits, prescriptions, and hospital stays. The LTC waiver covers the services that let an older adult actually stay at home.

The ALF and AFCH Distinction

Florida has two distinct license categories for residential personal-care settings, and the waiver covers both, but they're regulated separately.

• Assisted Living Facility (ALF), licensed under Ch. 429 Part I, F.S. No bed cap. The LTC waiver pays for the personal care and supportive services delivered within the ALF, but not room and board, which the resident pays from personal income. There are roughly 3,100 licensed ALFs in Florida.
• Adult Family Care Home (AFCH), licensed under Ch. 429 Part II, F.S. and Fla. Admin. Code Ch. 59A-37. Limited to a maximum of 5 unrelated adult residents, with the licensed provider living on-site. AFCHs are smaller, more home-like settings often run by a nurse, certified nursing assistant, or home health aide who has converted their own home into a licensed AFCH. The waiver pays for personal care and supervision in the AFCH; the member pays room and board from personal income.

Members residing in an ALF or AFCH retain a Personal Needs Allowance (PNA) of $160 per month (effective July 1, 2024 under HB 5001, the 2024-25 General Appropriations Act, which raised the figure from $54 and aligned it with the long-standing nursing-home PNA). Older sources citing the $54 PNA are obsolete.

The Participant-Directed Option (PDO): 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 the member act as the employer (or co-employer with a Fiscal/Employer Agent) and directly hire, train, schedule, supervise, and fire their own caregivers.

PDO is offered by every Florida LTC managed-care plan, the AHCA-Plan model contract requires it. To use PDO, the member must be community-dwelling: in their own home, a relative's home, or a similar community setting. PDO is not available while residing in an ALF, AFCH, or nursing facility.

Which Services Are PDO-Eligible

Under Florida's approved waiver and AHCA Exhibit II-B, the services that can be delivered through PDO are:

• Adult Companion Care
• Homemaker Services
• Personal Care / Attendant Care
• Intermittent and Skilled Nursing (skilled nursing tasks under PDO require a worker with the appropriate clinical license)
• In-Home Respite Care

Other services (ADHC, transportation, DME, hospice, etc.) are not PDO-eligible, they're delivered by the LTC plan's contracted network providers.

Who Can Be Hired, Including Spouses

This is where Florida's PDO differs from many other states. The following can be hired as a PDO Direct Service Worker:

• Adult children
• Siblings
• Parents of an adult member
• Other relatives
• Friends
• Neighbors
• Spouses, Florida's approved waiver explicitly contemplates "legally responsible individuals, including spouses" as PDO direct service workers. This is one of the more permissive consumer-direction programs in the country. The federal authority is the §1915(c) waiver flexibility under 42 CFR §441.301(c)(4)(vi), which allows states to pay legally responsible relatives in HCBS waivers as a state option. The state-plan prohibition at §440.167 doesn't apply here because the waiver authority overrides it.

A few important restrictions to keep in mind:

• The minimum age for any PDO worker is 18. A minor child of the member cannot be hired.
• A person serving as the member's PDO Representative cannot simultaneously be the paid Direct Service Worker for that member. If you're managing the program on behalf of a parent who can't manage their own care, you can be either the Representative or the worker, not both.
• A paid PDO worker cannot also receive Caregiver Training service hours, which are reserved for unpaid informal caregivers. The training and the paid work are mutually exclusive.
• Hiring a spouse can in some cases increase a couple's countable income for Medicaid eligibility purposes. This is a real planning consideration. Couples should review the spouse-as-worker decision with a Medicaid planner or elder-law attorney before electing PDO with a spouse-worker, especially in the year following Medicaid approval when the look-back rules are still active.

Worker Requirements

Every PDO Direct Service Worker must:

• Be at least 18 years old
• Be authorized to work in the United States
• Pass a Level 2 background screening (AHCA/FDLE/FBI fingerprint-based, under Ch. 435, F.S.)
• Sign a written PDO Direct Service Worker Agreement with the member or representative

Some LTC plans add basic CPR/first-aid orientation requirements; check with your specific plan's care manager.

The Fiscal/Employer Agent (F/EA), Vendor Splits by Plan

Florida uses a third-party Fiscal/Employer Agent to handle payroll, tax withholding, IRS Form 2678 / Section 3504 employer-of-record filings, EVV system access, and worker payments. The F/EA assignment differs by LTC plan:

Plan-vendor relationships occasionally shift. Confirm the current F/EA assignment with your LTC plan's care manager before recruiting workers.

Pay Rates and EVV

Workers are paid hourly out of an authorized care-plan budget set by the LTC plan's care manager. The member or PDO Representative determines the worker's specific hourly rate within that budget.

Florida's statewide minimum wage is currently $14.00/hour and is scheduled to rise to $15.00/hour on September 30, 2026 (the final step of the 2020 constitutional amendment, after which annual CPI-based adjustments begin in 2027). Skilled nursing PDO workers typically command higher rates that reflect their licensure.

Electronic Visit Verification (EVV) is mandatory for all PDO personal care and home health services under the federal 21st Century Cures Act §12006. Workers clock in and out via the F/EA's mobile app, IVR phone system, or web portal. EVV captures the worker's identity, the member's identity, the date, the start/end time, the service type, and the location. No EVV record means no pay.

How to Enroll in PDO

If you're already on the LTC waiver, request PDO through your LTC plan's care manager. The care manager confirms eligibility (community-dwelling, has at least one PDO-eligible service on the Plan of Care, member or representative is willing and able to manage the worker), assigns the F/EA, and walks you through orientation. The F/EA processes the Level 2 background screening for your worker, sets up payroll, and trains you on EVV.

A note on history: Florida's PDO has replaced the legacy Consumer Directed Care Plus (CDC+) program, which operated alongside earlier non-managed-care HCBS waivers. CDC+ was a separate "cash and counseling" model; PDO is the current SMMC LTC version. Older Florida sources may still reference CDC+, that program has been folded into PDO.

The LTC Plans: Statewide vs. Regional

Two LTC plans operate statewide across all 9 SMMC regions; four plans operate LTC contracts in select regions only.

Statewide LTC plans:

• Florida Community Care (FCC), an LTC-only specialty plan owned by Independent Living Systems. FCC is the only LTC-specialty plan in the roster; the other plans are comprehensive plans that hold MMA + LTC together where awarded.
• Humana Medical Plan / Humana Healthy Horizons, comprehensive plan; statewide LTC footprint.

Regional LTC plans (operating in select regions A–I):

• Aetna Better Health of Florida
• Simply Healthcare Plans (Elevance Health/Anthem)
• Sunshine State Health Plan (Centene)
• UnitedHealthcare Community Plan

AmeriHealth Caritas Florida exited Florida SMMC effective February 1, 2025 and is no longer an active SMMC plan; members in its prior counties were transitioned to other plans during the SMMC 3.0 launch. Older sources listing it as an LTC choice are obsolete.

Florida statute (F.S. 409.974) requires at least two LTC plan choices in every region. To find the LTC plans in your region, call the choice-counseling line at 1-877-711-3662 or visit flmedicaidmanagedcare.com.

What If You're Stuck on the Waitlist?

A common situation: a family applies, screens into Rank 4, and is told it could be 12+ months before a slot opens. In the meantime, mom is still struggling at home. A few things that may help in the gap:

• MEDS-AD (Regular Medicaid for Aged and Disabled) can still cover doctor visits, prescriptions, and hospital stays for community-dwelling seniors at $1,171/month (single) and $5,000 in assets. This is full-benefit Medicaid; it just doesn't cover HCBS services.
• Older Americans Act services through your AAA, home-delivered meals, congregate meals, transportation, caregiver respite, in-home services on a sliding-fee scale. These are funded through Title III of the Older Americans Act, not Medicaid, and are available regardless of waitlist status. Call the Elder Helpline at 1-800-963-5337.
• Community Care for the Elderly (CCE), a state-funded program administered by the AAAs that delivers HCBS to functionally impaired older adults at risk of nursing-facility placement, including those on the LTC waiver waitlist. Sliding-fee, not free, but more affordable than private-pay home care.
• Re-screening when status changes. If your loved one falls, is hospitalized, loses a primary caregiver, or shows signs of cognitive decline that weren't previously documented, call the AAA back for a 701S re-screen. The new score may shift them to a higher rank.
• APS 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 APS investigation. APS High Risk Referrals are Rank 8, the fastest path off the wait list. This is a legitimate use of APS, not a workaround; APS exists to protect vulnerable adults at risk of harm.

Frequently Asked Questions

My mother applied two months ago and we still haven't heard anything. What's happening? Several possibilities. First, she may have screened into Rank 1 or 2, which means she was not placed on the active waitlist. Call the AAA and ask explicitly: "What rank is my mother on the waitlist?" If she's Rank 1 or 2, ask whether her clinical situation has changed enough to warrant a re-screen. Second, if she's Rank 3–5, the wait can be many months. Third, the financial application (DCF/ACCESS Florida) is a separate track; check that status at myaccess.myflfamilies.com.

Can my dad use both Medicare and the SMMC LTC waiver? Yes, and most Florida LTC waiver members are dual-eligible. Medicare pays first for medical services (doctor visits, hospital stays, post-acute SNF care up to 100 days, home health when criteria are met). The LTC waiver pays for the long-term HCBS services Medicare doesn't cover (personal care, homemaker, ADHC, ALF, AFCH, etc.). The MCO and the LTC plan coordinate.

Does the waiver pay for assisted living? Yes, the personal care and supportive services delivered within an ALF, but not the room and board, which the member pays from personal income (typically all but the $160/month Personal Needs Allowance). Make sure the ALF you're considering has a contract with the LTC plan you're enrolled in.

My husband and I both need care. Can we both get on the waiver? Yes, with caveats. Each spouse goes through the eligibility tests independently, both must meet age, NHLOC, and financial requirements. Couples both applying for LTC are subject to the joint $5,964/month income limit and $3,000 combined asset limit. Each spouse gets their own waitlist rank based on their own 701S score.

My income is $3,500/month. Can I qualify with a QIT? Yes, but only if you set up the QIT before you apply. The QIT will receive the $518/month above the $2,982 cap each month and route it to your patient-responsibility share. Florida elder-law attorneys handle QIT setup for a flat fee, typically $300–$1,500. The QIT must be funded with the over-cap income each month, every month, for as long as you're on Medicaid LTC.

Can I hire my spouse through PDO? Yes, Florida is one of the more permissive states on this. Your spouse must meet all PDO worker requirements (age 18+, US work-authorized, Level 2 background screening, signed worker agreement). However, hiring a spouse can in some cases increase your couple's countable income for Medicaid eligibility purposes; review with a Medicaid planner before electing this.

What's the difference between LTC waiver, ICP, and MEDS-AD? LTC waiver pays for HCBS in the community, has a waitlist. ICP pays for full nursing-home care for residents 60+ days in a facility, is an entitlement, no waitlist, same financial test as LTC waiver. MEDS-AD is regular Medicaid for community-dwelling aged/disabled adults at $1,171/month single, is an entitlement, covers acute care, does NOT cover HCBS.

My mother is in a nursing home and wants to come back home. Can she? Probably yes, if she meets the LTC waiver eligibility tests. Nursing-home residents who have been in a Florida-licensed facility for 60+ consecutive days and want to transition back to the community get priority placement on the LTC waiver wait list. The Community Transition benefit funds up to $5,000 of one-time setup costs (security deposit, basic furniture, household goods). Talk to the nursing facility's social worker about starting the transition process.

Will my LTC plan change if I move to a different region? Possibly. If your current LTC plan operates in your new region, you keep the same plan. If it doesn't, you'll need to choose a new plan from those operating in your new region. Call the choice-counseling line at 1-877-711-3662 before you move.

Can I appeal a CARES denial? Yes. CARES NHLOC denials are appealable through Florida's Medicaid Fair Hearing process (Department of Children and Families, Office of Appeal Hearings). You have 90 days from the denial notice to file. You can also file a grievance with your LTC plan if a service is denied, reduced, or terminated after enrollment. Most denial appeals turn on documentation of clinical need; a letter from your loved one's primary care physician describing ADL impairment and clinical complexity can be decisive.

Does Florida still use CDC+ (Consumer Directed Care Plus)? No. CDC+ was a legacy cash-and-counseling program operating alongside earlier non-managed-care HCBS waivers. It has been folded into the Participant-Directed Option (PDO) under SMMC LTC. If you're seeing references to CDC+ in older documents, the current equivalent is PDO.

How is the FL PDO different from TX CDS or TN Consumer Direction? Each state's consumer-direction program has its own rules. Florida's PDO is on the more permissive end: spouses can be hired, the F/EA model is split between GT Independence and PPL, and PDO is required of every LTC plan. Texas CDS operates within STAR+PLUS and the §1915(c) waivers and has different family-eligibility rules. Tennessee's CD program is more restrictive, spouses, conservators, and POAs are explicitly barred. If you're comparison-shopping between states, the spouse-eligibility rule is often the deciding factor.

Where do I start? For most families: call the Elder Helpline at 1-800-963-5337. They route you to your local AAA, which conducts the 701S screening and tells you your waitlist rank. In parallel, file the financial application at myaccess.myflfamilies.com. If your loved one is already in a nursing home for 60+ days, talk to the facility's social worker about ICP and the LTC waiver transition path.

Learn More

• How to Apply for Florida Medicaid
• Florida Medicaid Eligibility & Income Limits
• Florida HCBS Waivers
• What Florida Medicaid Covers
• Florida Medicaid Managed Care Plans
• Florida Medicaid Programs Overview

Find personalized help with Florida's Long-Term Care waiver 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.