Assisted Living for the Elderly (ALE) Medicaid Waiver

DESCRIPTION OF SERVICES

The Assisted Living for the Elderly (ALE) Waiver is a home and community-based services program for recipients who reside in qualified assisted living facilities (ALFs). The waiver covers three services: case management, assisted living, and (if needed) incontinence supplies. The components of assisted living that may be provided include: attendant call system, attendant care, behavior management, chore, companion services, homemaker, intermittent nursing, medication administration (within the ALF license requirements), occupational therapy, personal care, physical therapy, specialized medical equipment and supplies, speech therapy, and therapeutic social and recreational services.

Recipients make an informed choice of receiving home and community-based services in lieu of nursing facility care.

FUNCTIONAL ELIGIBILITY

To be functionally eligible for the ALE waiver, an individual must be:

• Age 65 and older, or
• Ages 60 through 64 and determined disabled according to Social Security standards.

AND meet one or more of the following:

• Require assistance with four or more activities of daily living (ADLs);
• Require assistance with three ADLs plus supervision or administration of medication;
• Require total help with one or more ADLs;
• Have a diagnosis of Alzheimer's disease or another type of dementia and require assistance with two or more ADLs;
• Have a diagnosed degenerative or chronic medical condition requiring nursing services that cannot be provided in a standard ALF, but are available in an ALF licensed for limited nursing or extended congregate care; or
• Be a Medicaid-eligible recipient who meets ALF residency criteria; be awaiting discharge from a nursing facility; and be unable to return to a private residence because of a need for supervision, personal care, periodic nursing services, or a combination of the three.

Note: To qualify for the ALE Medicaid Waiver program, a recipient must meet the Institutional Care Program (ICP) Level of Care as determined by the Department of Elder Affairs CARES unit within each Planning and Service Area (PSA) .

FINANCIAL ELIGIBILITY

To be financially eligible for the ALE Waiver Program, an individual must meet Supplemental Security Income (SSI), MEDS-AD or Medicaid Waiver Assistance (MWA) income and asset requirements. The income limit figures are modified annually based upon the federal cost of living adjustment granted to Social Security beneficiaries. The applicable income limit for 2008 is $1911 for an individual. The asset limit is $2000. The Assisted Living Waiver does not reimburse facilities for room and board. The Department of Children and Families establishes the amount allowed for room and board for consumers who are served by Florida's Optional State Supplementation program.

RECIPIENT APPLICATION FOR SERVICES

Individuals who meet the criteria above may contact the Medicaid waiver specialists from the Area Agency on Aging in their Planning and Service Area (PSA) regarding enrollment in the ALE Waiver.

PROVIDER REIMBURSEMENT

Medicaid reimburses for assisted living services on a daily rate for each day the individual is receiving services in the facility, plus incontinence supplies if applicable. Currently, the maximum daily rate for assisted living services is $32.20 , and the monthly maximum for incontinence supplies is $125.00. The daily rate may be reduced if the resident has excess income or is eligible for Assistive Care Services .