Florida Medicaid’s Covered Services and HCBS Waivers
Nursing Facility Services
Medicaid reimburses for 365 days of all-inclusive nursing facility services, per year, per recipient when the following occurs:
- Services are prescribed by a physician licensed in the state of Florida
- Recipient occupies a Medicaid-certified bed
Nursing facility services include the following as applicable:
- On-site physician services
- Person-centered care planning
- Activity services
- Dietary services, including therapeutic diets and special dietary supplements used for oral or tube feeding
- Dressing and skin care items
- All general nursing services, including restorative nursing
- Laundry services
- Medical supplies and equipment
- Non-prescription (over-the-counter) drugs, biologicals, and emergency drugs
- Personal hygiene care
- Personal hygiene items, including incontinence supplies
- Rehabilitative services, including physical, speech, and occupational therapies
- Room and board
- Social services
This service is one of the minimum covered services for Managed Medical Assistance, Long-Term Care and Comprehensive Long-Term Care plans serving Medicaid enrollees.
Eligibility
Florida Medicaid recipients requiring medically necessary nursing facility services who meet the following criteria:
- Meets the criteria for Institutional Care Program (ICP) Medicaid as determined by the Department of Children and Families
- Meets the level of care requirements determined by the Comprehensive Assessment and Review for Long-Term Care (CARES) program for recipients 21 years of age or older or by the Children’s Multidisciplinary Assessment Team (CMAT) for recipients 20 years of age or younger
- A physician specifies the need for institutional nursing care
- Has had a Pre-Admission Screening and Resident Review completed.
Resource Information
Information on Medicaid health plans and services is available on the Statewide Medicaid Managed Care webpage.
The Florida Medicaid coverage policies, fee schedules, and Rule are available on the Agency Website.
