Before Florida Medicaid will pay for a nursing home or in-home care through the SMMC Long-Term Care program, a state nurse or assessor has to say your parent needs that level of care. Here is how that step actually works in Central Florida.
By Orlando Senior Advisor Care Team · September 11, 2026
Families in Orange, Osceola, Seminole, Lake, and Sumter counties routinely tell us they "applied for Medicaid" and are waiting to hear back. Almost always they have started only half the process. Florida's long-term care Medicaid runs on two independent tracks, handled by two different agencies, and a person has to clear both.
The financial track belongs to the Department of Children and Families through the ACCESS Florida system — income, assets, transfers, and the five-year lookback. The medical track belongs to the Department of Elder Affairs through a program called CARES: Comprehensive Assessment and Review for Long-Term Care Services. CARES decides whether the applicant clinically needs nursing-facility level of care. A person can be financially eligible and still be denied because CARES found the care need did not rise to that level, and the reverse happens just as often.
A CARES assessor — usually a registered nurse or a trained human-services counselor — meets with the applicant, in the hospital, at a rehab facility, at home, or in an assisted living community. The visit is a structured interview built around a state form, the 701B comprehensive assessment. Expect it to take roughly an hour, sometimes longer if cognition is in question.
The assessor is documenting function, not diagnosis. How much hands-on help does this person need to bathe, dress, transfer from bed to chair, use the toilet, and eat? Can they manage medications on their own? Is there wandering, exit-seeking, or behavior that requires supervision? Are there skilled needs such as wound care, tube feeding, or oxygen? A long list of diagnoses on paper does not qualify anyone. Documented dependence in activities of daily living, or a cognitive impairment that requires supervision, is what does.
This is the single most common place families undersell themselves. Many caregivers, out of pride or habit, describe a good day. The assessor is only there once. Describe the hardest days honestly, and say plainly how much you are doing — the 3 a.m. bathroom trips, the meals that go uneaten unless someone sits there, the medication box you refill because it was being taken twice.
If your parent is in an Orlando-area hospital or a rehab stay at a skilled nursing facility, the discharge planner or social worker can request the CARES review directly, and it usually moves quickly because a discharge date is pressing.
In the community, the entry point is the Aging and Disability Resource Center. For Orange, Osceola, Seminole, and Brevard counties, that is Senior Resource Alliance, reachable through the statewide Elder Helpline at 1-800-963-5337. Lake and Sumter counties, including The Villages, are served by the Elder Options ADRC in Gainesville, reachable at the same helpline number. Your first call there produces a shorter telephone screening — form 701S — that assigns a priority score.
That priority score matters more than most families realize. Home and community-based slots in the SMMC Long-Term Care program are limited, and Florida releases them from a managed wait list by priority rank, not by the date you called. A higher-need applicant who screened last month can be released ahead of a lower-need applicant who has waited a year. If your parent's condition worsens while waiting, call back and ask for a rescreen — nobody will do it for you.
A CARES approval is a level-of-care determination, not a plan of care and not a payment. Once both the medical and financial approvals are in place and a waiver slot is released, the enrollee chooses a managed care plan from the SMMC Long-Term Care plans operating in their region, and that plan's case manager builds the actual service package — personal care hours, adult day care, respite, home-delivered meals, home modifications, or assisted living facility services.
One point that surprises nearly every family: the waiver can pay a participating assisted living facility for care and services, but it never pays room and board. The resident's income covers that, usually leaving a small personal-needs allowance. That gap is why the list of Orlando-area communities that actually accept waiver residents is much shorter than the list of licensed communities, and why it is worth knowing which ones do before you tour anywhere.
Determinations expire and get redone. Keep copies of everything, note the assessor's name, and if you are denied, ask for the written notice — it carries appeal rights and a deadline.
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