Long-term Care Diversion Program
Description:
The Long-Term Care Community Diversion Program (Diversion) is designed to provide home and community based services to older persons assessed as being frail, functionally impaired and at risk of nursing home placement. An array of Long-Term care services, Medicaid covered medical services and Medicare services are coordinated and delivered through managed care organizations (MCOs) contracted with the Department. Diversion provides these alternatives at a cost less than Medicaid nursing home care.
Services or Activities:
Diversion waiver services include a choice of at least two providers for case management, adult companion, adult day health, assisted living, chore, consumable medical supplies, environmental accessibility and adaptation, escort, family training, financial assessment and risk reduction, home delivered meals, homemaker, nutritional assessment and risk reduction, personal care, personal emergency response systems, respite care, occupational, physical and speech therapies, home health and nursing facility services.
Acute-care services are covered for Medicaid recipients based on the Medicaid state plan approved by the federal Centers for Medicare and Medicaid Services. These services are covered in the project to the extent that they are not covered by Medicare or are reimbursed by Medicaid pursuant to Medicaid’s Medicare cost-sharing policies and included in the capitation rate. Managed care organizations contracted with the Department under the Diversion Program are responsible for Medicare co-payments and deductibles. The acute-care services include community mental health services, independent laboratory and x-ray, inpatient hospital and outpatient hospital/emergency, physicians, prescribed drugs and transportation (optional) services.
All of these services are available based on medical necessity, or they must be necessary in order to delay or prevent nursing facility placement.
Program Eligibility:
Individuals that meet the following criteria are eligible to receive services under the Diversion Program:
- Age 65 and over
- Dually eligible for Medicaid and Medicare Parts A & B
- Live in the authorized program areas
- Be determined by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit at the Department of Elder Affairs to be at nursing home level of care and meet one or more established clinical criteria.
For more information on medical eligibility, please contact your local CARES office.
For more information on financial eligibility, please call 1-866-76-ACCESS (1-866-762-2237) or visit http://www.dcf.state.fl.us/ess/medicaid.shtml. You can apply for Medicaid online at http://www.myflorida.com/accessflorida or contact your local Florida Department of Children and Families office. Each program has its own income and asset requirements.
The Social Security Administration determines eligibility for the Supplemental Security Income (SSI) program.
The SSI-Related Programs Fact Sheet contains information about Medicaid eligibility criteria for the aged, blind and disabled, including Medicare cost-sharing coverage for Qualified Medicare Beneficiaries (QMBs), Specified Low-Income Beneficiaries (SLMBs), and coverage for Qualified Individuals.
Program Reports
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