Recently I learned about a new (for me) resource for the elderly in the state of Florida. The Long-term Care Community Diversion Program is a Medicaid waiver program designed to provide services and community-based resources to people who would otherwise qualify for Medicaid nursing home placement. The objective of the Diversion Program is to provide frail elders with safe, appropriate, community-based care alternatives in lieu of nursing home placement, at a cost less than Medicaid nursing home care.
Managed care organizations and other qualified providers enter into a contract with the state and receive a capitated payment to provide, manage and coordinate a qualified enrollee's full continuum of care. Generally speaking, the program provides care through contracted providers, which can include home health agencies, transportation companies, durable medical equipment companies, food services vendors and other provides who meet the nonmedical needs.
Individuals have to meet criteria to be eligible for the Diversion Program. They need to be:
- 65 years of age or older.
- Reside in a Diversion Project service area.
- Be a Florida resident.
- Be a U.S. citizen or qualified noncitizen.
- File for any other benefits to which they may be entitled.
- Disclose any rights to third party liability (i.e., health insurance).
- Have Medicare part A and part B.
- Meet nursing facility level of care criteria and additional clinical criteria as determined by the Department of Elder Affairs' CARES Unit.
- Meet the income limit of $2022 for an individual or $4044 for a couple.
- Meet the asset limit of $2000 for an individual or $3000 for an eligible couple.
- Have difficulty performing activities of daily living.
The program uses case managers to educate patients and families about the program, complete an assessment, develop the plan of care, assist them in getting services and conduct ongoing monitoring to ensure that the plan of care is working for them.
The person I spoke to about this program shared that the program is dependent on funding and can shut down at any time if they run out of funds. When the program is functioning, it meets a very important need for helping families and seniors age in place and ensure quality of life and dignity for people in the late stages of their lives.
If you are working with seniors and their families, check to see if your state has a program in place such as this as it can be an important resource. To learn about the how organization measure value from the program, you can
review a presentation from the Lewin Group who share a format to measure outcomes.
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