Florida home care programs

Home health: the medical benefit

In Florida, skilled home health is Florida Medicaid Home Health Services (home health visits) (HH). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Florida Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Florida the agency route is Florida Medicaid Personal Care Services (PCS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.

Consumer-directed care: the person hires their own aide

Florida's consumer-directed option is Consumer-Directed Care Plus (CDC+) and Participant Direction Option (PDO). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Consumer-Directed Care Plus (CDC+) and Participant Direction Option (PDO) allow a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Florida has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Consumer-Directed Care Plus (CDC+) and Participant Direction Option (PDO)), by the hour, as the participant's chosen aide.

Other ways Florida pays for care at home

Waiver in-home services: Developmental Disabilities Individual Budgeting Waiver (iBudget Florida) and Statewide Medicaid Managed Care Long-term Care (LTC) Program. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: Community Care for the Elderly (CCE) and Home Care for the Elderly (HCE). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Also: Home Health Aide for Medically Fragile Children Program (Family Home Health Aide services) (FHHA).

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Florida Medicaid Home Health Services (home health visits) (HH)).
• Needs daily help and wants an agency to supply and manage the aide: Florida Medicaid Personal Care Services (PCS).
• Wants to choose the aide, including a relative where allowed: Consumer-Directed Care Plus (CDC+) and Participant Direction Option (PDO).
• Meets nursing-home level of care and needs more than personal care: Developmental Disabilities Individual Budgeting Waiver (iBudget Florida) and Statewide Medicaid Managed Care Long-term Care (LTC) Program.