Frequently Asked Questions
What is IDD and who qualifies for services in Florida?
In Florida, IDD stands for Intellectual and Developmental Disabilities, and it refers to a range of conditions that affect a person’s intellectual and social development, impacting their ability to learn, adapt, and function in daily life.To qualify for IDD services in Florida, individuals must be Florida residents, aged 18 or older, meet specific eligibility requirements, and be diagnosed with a qualifying disability, as well as be eligible for Medicaid and reside in specific pilot regions.
What is the Florida Medicaid iBudget Waiver?
The Florida Medicaid iBudget Waiver is a home and community-based services waiver program for individuals with developmental disabilities. It allows eligible people to receive services in their homes or communities, promoting self-determination and preventing institutionalization. The program is managed by the Agency for Persons with Disabilities (APD) and funded through Medicaid.
How do I apply for the iBudget Medicaid Waiver?
To apply for the iBudget Medicaid Waiver in Florida, you need to submit an application to the Agency for Persons with Disabilities (APD) regional office where you reside. You can also apply online through the APD website. The iBudget Waiver is a Home and Community-Based Services (HCBS) waiver that provides individuals with developmental disabilities with flexibility to choose medically necessary services.
Detailed Breakdown of the Application Process
- Determine Eligibility:Ensure you meet the eligibility requirements for the iBudget Waiver, which include:
- Being a Florida resident.
- Having a diagnosis of a developmental disability.
- Meeting the level of care criteria for an Intermediate Care Facility for the Developmentally Disabled (ICF/IID).
- Being eligible for Medicaid.
- Gather Necessary Documents: You will need to provide documentation to support your application, including proof of residency, diagnosis, and financial information.
- Submit the Application: You can apply online through the APD website or by submitting a paper application to the APD regional office serving your area.
- Wait for Determination: The APD will review your application and determine if you are eligible for the iBudget Waiver.
- Enrollment: If approved, you will need to enroll in the iBudget Waiver program. This may involve signing a Medicaid Waiver Services Agreement (MWSA) with APD.
Additional Information:
- There is a waitlist for enrollment into the iBudget Waiver program.
- You may need to meet “crisis priority” to move off the waitlist.
- The APD provides resources and information about the iBudget Waiver on their website.
How long is the waitlist for the iBudget Waiver?
The waitlist for the iBudget Waiver in Florida can be very long, with some individuals waiting for years to receive services. In 2024, the average wait time was 40 months, according to a KFF report. The waitlist was first over 20,000 in May 2011, and as of January 2023, there were 22,372 people on the waitlist. While waiting, individuals may still be eligible for other types of Home and Community Based Services (HCBS).
How Do I find a Waiver Support Coordinator in my Area?
To find a Waiver Support Coordinator (WSC) in your area, you can use the Agency for Persons with Disabilities (APD) Waiver Support Scorecard or the Florida Developmental Disabilities Resources website. Both resources allow you to search for WSCs by county or region.
You can also contact your local APD Regional Office for personalized assistance or request a specific WSC. Alternatively, you can connect with other families and support groups, join Family Care Councils, Advancing Families and Individuals Needing Services (AFINS), or Facebook groups for personal recommendations.
How do I find an iBudget waiver service provider in my area?
To find iBudget waiver service providers in your area, you can use the Florida Developmental Disabilities Resources website and search by county or by APD region. You can also specify the type of service you need.
You can also contact your local APD Regional Office for personalized assistance or ask your Waiver Support Coordinator (WSC). They should have access to updated directories and availability information. Alternatively, you can connect with other families and support groups, join Family Care Councils, Advancing Families and Individuals Needing Services (AFINS), or Facebook groups for personal recommendations.
What services and products are available through the iBudget Waiver?
The Florida iBudget Waiver provides a wide range of services and products to individuals with developmental disabilities, aimed at promoting independence and community living. These include assistance with daily living activities, therapeutic support, and specialized services like behavior analysis and mental health counseling.
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Can I work and still receive services through the iBudget Waiver?
Yes, you can work and still receive services through the iBudget Waiver program in Florida. The iBudget Waiver is designed to help individuals with intellectual and developmental disabilities live and work in their own homes and communities.
What happens if I don’t use all allocated hours in my APD service plan?
If you don’t use all your allocated hours with the Florida Agency for Persons with Disabilities (APD) within your service plan period, the unused hours generally do not carry over to the next period. Providers should bill for all days an individual is present in the program up to a yearly maximum, and are expected to continue providing services even if the maximum is reached before the year’s end.
Detailed Breakdown of Allocated Hours Not Being Utilized
- Short-term: Unused hours do not accumulate and cannot be carried over to the next month.
- Long-term: Prolonged underutilization may result in a reduction of your budget or service authorization during the next support plan review. APD may assume that the full allocated hours are not necessary.
- Important Note: It is crucial to document instances where services were unable to be utilized due to staff shortages, illness, or other valid reasons. This documentation safeguards your future allocation.
What is the difference between the Florida iBudget Waiver and regular Medicaid?
iBudget is a Florida Medicaid Home and Community-Based Services (HCBS) waiver designed for individuals with developmental disabilities. Regular Medicaid, on the other hand, provides a broader range of medical services to a wider population. iBudget focuses on long-term care and supports for individuals with developmental disabilities, offering them more flexibility and choice in their care.
Detailed Breakdown
- Target Population: Individuals with developmental disabilities who meet specific criteria, including a need for the level of care typically provided in an intermediate care facility.
- Services: Focuses on services like supported living, supported employment, and other community-based supports to help individuals with disabilities live independently.
- Flexibility: Allows individuals more control over their care, including choosing providers and services that best meet their needs.
- Individual Budgeting: The “iBudget” name reflects a system where individuals are allocated a budget to spend on their supports and services, with flexibility to choose how to use those funds.
- Administration: Administered by the Agency for Persons with Disabilities (APD).
- Administration: Administered by the Florida Agency for Health Care Administration (AHCA).
- Target Population: A broad range of individuals, including low-income families, children, seniors, and individuals with disabilities.
- Services: Covers a wide array of medical services, including doctor visits, hospital care, prescription drugs, and mental health services.
- Flexibility: While regular Medicaid offers a range of benefits, it may not always provide the same level of flexibility and choice as iBudget, particularly regarding long-term care and supports.
What is Consumer-Directed Care Plus (CDC+)?
Consumer-Directed Care Plus (CDC+) is a Florida Medicaid program that allows individuals to directly manage their own long-term care services, including choosing their own providers and setting their own schedules. It’s an alternative to traditional Medicaid Home and Community-Based Services (HCBS) waivers, empowering participants to make decisions about their care and achieve their goals.
Key Features
- Choice and Control: Individuals have the flexibility to select their care providers, schedule services, and determine how their budget is spent.
- Self-Direction: Participants are expected to be involved in all aspects of planning their care, including choosing services, providers, and how they will be delivered.
- Flexibility: The program allows for more personalized support and services to meet individual needs and preferences.
- Increased Satisfaction: CDC+ participants report higher levels of satisfaction with their care and services.
- Independence: The program promotes greater self-determination and independence for individuals.
Video Introduction
Who is eligible for Consumer-Directed Care Plus (CDC+)?
In Florida, individuals are eligible for Consumer Directed Care Plus (CDC+) if they meet specific criteria, including being a current consumer under the Medicaid Waiver program, living in a family home or their own home, complete CDC+ training, and pass a Readiness Review test.
Video Introduction
Can I appeal APD or iBudget Waiver decisions?
In Florida, if the Florida Agency for Persons with Disabilities (APD) denies a hearing request, the applicant has the right to appeal the decision within 30 days of the date of the Final Order. This appeal is filed with the appropriate District Court of Appeal. The Final Order will provide details about how to file the appeal. Additionally, if an applicant disagrees with an agency’s decision, they can request a hearing within 30 days of receiving written notice of the agency’s intended action. It’s important to submit paperwork promptly and document everything.
How do I submit a Crisis Request from APD?
Individuals currently experiencing homelessness who exhibit life-threatening behaviors that pose an imminent risk to themselves or others, or who have a caregiver in extreme distress and unable to provide for their health and safety, may submit a request for crisis enrollment through the Agency for Persons with Disabilities (APD) iBudget Waiver program. Unlike the regular iBudget waiver process, there is no waitlist for crisis enrollment. This means that individuals in genuine crisis situations, such as those at immediate risk of harm, homelessness, or losing a caregiver, are not required to wait in line like others on the regular iBudget waiver waitlist. Instead, crisis cases are reviewed on a faster track to promptly intervene and prevent serious harm.
If you are in need of short-term emergency services, please contact your regional office serving your area or your Waiver Support Coordinator, if you have one. APD will review your situation to determine if a crisis waiver enrollment request is appropriate. To expedite your request, it is essential to thoroughly document the circumstances. Include relevant documentation such as doctor’s notes, Department of Children and Families (DCF) reports, eviction notices, police reports, or hospital discharges.
Upon receipt of your request, APD has 45 days to approve or deny the crisis enrollment. It is crucial to request a written response from APD in all cases. If your request is denied, you have the right to appeal the decision.
What’s changing with the iBudget Redesign?
The Florida iBudget program, a Medicaid waiver for individuals with developmental disabilities, is undergoing a redesign and expansion. This includes a broader service called “Personal Supports” that encompasses various existing supports. Additionally, there’s a shift towards a more needs-based assessment tool (NG-QSI) to replace the previous algorithm, aiming for more equitable resource allocation and flexibility. A significant change is the automatic assignment of iBudget recipients to a managed care plan under the Statewide Medicaid Managed Care (SMMC) program, starting in February 2025.
Key Changes
1. New Service – Personal Supports:
- The “Personal Supports” service is a broader umbrella that encompasses current services like personal care, companion care, in-home supports, and respite care.
- This allows for greater flexibility in the types of tasks a worker can perform for an individual.
2. New Assessment Tool – NG-QSI:
- The NG-QSI assessment tool is being implemented to replace the previous algorithm.
- It will collect functional, physical, behavioral, and demographic information to better understand individual needs and support requirements.
- This will help with budget predictability and service identification while maintaining the flexibility of the iBudget waiver.
- The NG-QSI will also assess natural support levels, including caregiver details and living situations.
- This change will require statutory and rule modifications.
3. Statewide Medicaid Managed Care (SMMC) Integration:
- Beginning in February 2025, all voluntary Medicaid recipients, including iBudget recipients, will be automatically assigned to a managed care plan by the Agency for Health Care Administration (AHCA).
- Recipients will receive a letter explaining this change.
- This shift aims to integrate iBudget recipients into the broader SMMC program.
4. Other Key Changes:
- The Agency for Persons with Disabilities (APD) is working to ensure that Adult Day Training (ADT) and Supported Employment services are compliant with the Home and Community-Based Settings (HCBS) Rule.
- Florida has until March 2023 to achieve compliance with these regulations.
- Disability Rights Florida and the Florida Agency for Health Care Administration (AHCA) have proposed significant language changes to the Medicaid Developmental Disabilities (“iBudget”) Waiver.
How do I contact Department of Children and Families?
- By Phone: Call DCF customer call center at (850) 300-4323.
- Online: Start at the DCF home page, or go directly to the their MyACCESS portal to start the application process.
- Visit a Family Resource Center: Go to the DCF Family Resource Centers webpage to locate a facility by facility name, city, county or zip code.
You may do the following at the Family Resource Center without an appointment:
- Drop off any documentation
- Provide ID for authentication
- Use a computer to apply for government assistance
- Receive Department forms
All other services are by appointment only. Click here to make an appointment.
What are asset limitations for Medicaid in Florida?
Long-Term Care Medicaid (Nursing Home / HCBS Waiver / iBudget Waiver)
- Single Applicant: $2,000 in countable assets.
- Married Couple (both applying): $3,000 combined.
- Married Couple (one applying): $2,000 for the applicant; up to $157,920 for the non-applicant spouse (Community Spouse Resource Allowance).
Exempt (Non-Countable) Assets
- Primary residence (if equity is below $730,000).
- One vehicle.
- Personal belongings and household items.
- Prepaid funeral and burial plans.
- Certain retirement accounts, if structured properly.
Important Considerations
- Asset Transfers: Transferring assets to qualify for Medicaid can trigger a penalty period, delaying eligibility.
- Income Limits: In addition to asset limits, Medicaid has income limits. For 2025, the income cap for long-term care Medicaid is $2,901 per month. If income exceeds this, a Qualified Income Trust may be necessary.
What is 2-1-1 phone service?
22-1-1 is a free, multilingual, confidential telephone service that supports community well-being. It provides information and referrals to non-emergency services, including assistance with housing, food, healthcare, employment, and more. 2-1-1 serves as a centralized resource for connecting individuals with appropriate assistance, and it is available 24/7/365. 2-1-1 facilitates access to local resources and services tailored to the specific needs of callers.
How to Use 2-1-1
- Call: Dial 211 on your phone.
- Visit the website: Search online for 211 in your area, or visit the United Way’s 211 website (www.211.org).
- Text: Text your zip code to 898-211 for assistance.
