Assistive Care Services

This service is for low-income residents of enrolled assisted living facilities (ALFs), qualified residential treatment facilities (RTFs) and adult family-care homes (AFCHs). The purpose of the Medicaid Assistive Care Services Program is to increase state payments for recipients requiring an integrated set of services on a 24-hour per day basis. These services, provided by the residential care facilities, promote and maintain the health of eligible recipients in order to delay or prevent institutionalization. To accomplish this goal, funds are transferred from the Department of Children and Families (http://www.state.fl.us/cf_web) to Medicaid to draw down federal Title XIX matching funds.

What is assistive care?

This Medicaid optional state plan service is provided to low-income people who live in ALFs, AFCHs, and RTFs. Services are provided to individuals who demonstrate functional limitations and must be based on need as confirmed by an assessment and provided in accordance with an individual service plan for each resident.

What kinds of services are provided?

Assistive care services are similar to services typically provided in residential care facilities to residents who require an integrated set of services on a 24-hour basis. They include assistance with activities of daily living, assistance with instrumental activities of daily living, medication assistance, and health support. The services will be specified in a resident care plan developed from an annual assessment.

Who will provide Medicaid Assistive Care Services?

Three types of residences may qualify as Medicaid assistive care service providers: assisted living facilities, mental health residential treatment facilities, and adult family-care homes.

When did services begin?

Assistive Care Services were implemented in ALFs September 1, 2001, in qualified RTFs November 1, 2001, and in adult family care homes January 1, 2002.

What are the regulations governing the ACS Program?

The Agency adopted a new rule governing Assistive Care Services, Rule 59G-4.025, F.A.C., with a Provider Handbook incorporated by reference. The Provider Handbook also includes updated requirements for the Assisted Living for the Elderly Waiver Program administered by the Department of Elder Affairs. The handbook is available on the Medicaid fiscal agent, ACS State Healthcare (http://floridamedicaid.acs-inc.com), web site at no charge.

What other regulations are applicable?

ACS providers must comply with the requirements of the Medicaid Provider Reimbursement Handbook, which is incorporated by reference in Rule 59G-5.020, F.A.C., and which is posted on the Medicaid fiscal agent’s web site. ACS providers must also comply with the licensure requirements applicable to the facility type.

How is eligibility determined and who can receive ACS services?

The Department of Children and Families is responsible for determining the individual’s Optional State Supplementation (OSS) and Medicaid Eligibility. To receive assistive care services, recipients must be 18 years of age or older and meet these requirements:

• Be Medicaid eligible;
• Have a health assessment completed by a physician or other licensed health practitioner which indicates the medical necessity of assistive care services; and
• Reside in a Medicaid enrolled assisted living facility, qualified residential treatment facility or adult family-care home.

How can I learn more about this program?

Please contact the Bureau of Medicaid Services at (850) 487-2618 or write to us at:

Assistive Care Services
AHCA Bureau of Medicaid Services
2727 Mahan Drive, Mail Stop 20
Tallahassee, Florida 32308

Last updated December 2005