It is difficult enough
to come to terms with the reality of having to find a Skilled
Nursing or Residential Care Facility for you or a loved one
but to find one that is a great fit can take time and, sometimes,
may take a couple of tries before a perfect “home”
can be found.
The first question people
ask when faced with this new reality is “where do I begin
my search?” Searching for a facility through this very
site, Assisted Living Directory, will make your search a little
easier. Using the checklist on this site can be invaluable as
The second question
people tend to ask is “how can I afford to pay
for this facility and these services?” Financial
worry can add a great deal of stress to an already difficult
(and usually unwanted) situation. The reality is assisted living
can be costly. However, nationwide over 50% of residents use
some form of Medicaid to pay for nursing home or assisted living
care. Payment through private pay and insurance make up the
Many states have created
specific waiver programs within their federally funded Medicaid
programs to help defray these costs. Some states do not have
separate waiver programs but still help cover the costs of skilled
or assisted living facilities (or home health care) through
their Medicaid program. It is oftentimes difficult and confusing
to navigate through these programs but the financial assistance
is well worth the effort.
is one state with a waiver program designed
to help cover the cost of long term care. Information about
the program and how to navigate the waiver system is described
What is ALE?
The Assisted Living for the Elderly Waiver has been designed
for individuals who are at risk of nursing home placement and
covers three specific areas of care including case management,
assisted living and incontinence supplies (if needed). Recipients
must live in a Qualified Assisting Living Facility and services
provided include occupational therapy, physical therapy, personal
care, recreational services as well as many more. The waiver
does not pay for the room and board directly but through Affordable
Assisted Living facilities a person on limited income would
be able to pay for the services. Additional information about
specific coverage can be found at the Florida Department of
Elder Affairs website (http://elderaffairs.state.fl.us/faal/operator/alemedicaid.html).
Who is Eligible?
There are three parts of the eligibility process: general, medical
To be eligible for the Florida Assisted Living for the Elderly
Waiver, a person needs to be 65 years or older or aged 60 –
64 years and disabled (according to the Social Security standards).
The applicant also needs to be a resident of Florida as well
as a US citizen.
eligibility for the ALE requires meeting the same financial
requirements of Supplemental Security Income. Income and asset
limits are modified annually but for 2012 the income limit for
an individual is $2,094 and the asset limit for an individual
eligibility involves needing assistance with four or more activities
of daily living or a diagnosis of Alzheimer’s Disease
(or other type of dementia) or having a diagnosed degenerative
condition. A person can also meet eligibility requirements if
awaiting discharge from a nursing facility and who meets Assisted
Living Facility criteria. To be sure of all of the eligibility
requirements please check the Florida Department of Elder Affairs
How Do I Apply?
to provide documentation supporting financial and non-financial
eligibility so gather tax documents as well as your social security
card and birth certificate. It may also be helpful to have a
loved one or other representative work on your behalf to become
eligible for the Assisted Living Waiver. Applications must be
completed by contacting the Aging Resource Center in your Planning
and Service Area (PSA). A list of the Planning and Service Areas
in Florida can be found through the Florida Department of Elder
Affairs at http://elderaffairs.state.fl.us/doea/arc.php.
If assistance is needed with financial matters at Social Security,
it is possible to appoint a Representative Payee (ask how to
do this at your local Social Security office). This can be useful
when navigating the various programs available through Social
Security. The Medicaid system will have their own additional
forms to complete in order to appoint a representative.
if I am Denied? Many people are denied benefits
or acceptance into the Assisted Living for the Elderly Waiver
program but do not let this be discouraging news. Mistakes are
made and reversals can happen. Appealing a denial is strongly
encouraged. However, please note the program has limited funding
and, unfortunately, not everyone who applies and meets eligibility
requirements will be accepted into the program.
Keep in mind, there
are always a specific set of rules for the appeals process which
can bring a reversal of the denial. It is important to know
the appeal process and to follow the instructions and timeline
carefully. Contact the Florida Department of Elder Affairs for
specific instructions on how to appeal.
Once approved for the
ALE program, many care facilities are available throughout Florida
to provide services and care for you or a loved one. Once this
worry is resolved, the Sunshine State will be looking particularly
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- Article by Trish
Hughes Kreis exclusively for Assisted Living Directory