Florida Medicaid pays for in-home personal care and related services through the Statewide Medicaid Managed Care Long-term Care (SMMC LTC) Program. Florida operates the SMMC LTC program under combined 1915(b)/(c) Waiver authority. Over two dozen home and community-based services and nursing facility services are reimbursed through the program. AHCA administers and sets policy; DCF determines financial eligibility; the Department of Elder Affairs (DOEA) determines medical eligibility.
Which Florida waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Statewide Medicaid Managed Care Long-term Care (SMMC LTC) Program
Population
Adults 18 and older who need long-term services and support and meet nursing facility level of care
Services covered
personal care in-home services
home and community-based services
nursing facility services
hospice
adult day health care
homemaker
respite
Billing format
Capitated managed care via LTC plans; EVV via HHAeXchange or an alternate EVV system
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.