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Elder Law & Special Needs Planning
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How to apply for Nursing Home Diversion and other Waiver Programs
Call local CARES (Comprehensive Assessment and Review for Long Term Care Services) office with demographic information (name, DOB, address & SSN). Find your local CARES office
Nurse or assessor from CARES will call facility where client is located
If client is only seeking Nursing Home Diversion Waiver[1], CARES will complete a telephone screen and will complete a 701B Assessment.
Priority is based partially on functional deficits and social supports, and other items included on the 701B
CARES computer system uses responses to 701B to generate the priority score
Financial situation does not factor into priority
Priority scores range from 1 to 5, 5 being the highest/most frail clients
Client is entered into EMS – Enrollment Management System (waiting list)
Client must be 65 or older and have Medicare parts A & B
Client must require some help or supervision with 5 activities of daily living (ADL) such as bathing, dressing, walking, toileting, eating, transferring, OR
Require some help with 4 ADL plus require supervision of medications, OR
Require some help with 3 ADL and have a diagnosis of Alzheimer’s Disease, OR
Require total help with 2 ADL, OR
Have a diagnosis of a degenerative or chronic condition requiring daily nursing services.
Client should be financially eligible when added to list, but since CARES doesn’t evaluate financial eligibility, it is not necessary. At the very least, a plan should be put in place so that eligibility can be achieved very quickly
Once a spot opens up for a client, client becomes a new case for CARES.
A full onsite assessment is done
CARES obtains a 3008 Medical Certification form from doctor
CARES will make a formal functional/medical eligibility decision
If client is eligible medically, financial eligibility must be shown
If not eligible medically, no nursing home diversion
Application is filed thru DCF (financial)
Eligibility criteria and rules are the same as for ICP
Pick a Diversion Provider
Click here for a list of providers in your county
Click here for a list of providers’ websites
Not all providers have contracts with all assisted living facilities
Providers may offer different services
It is a good idea to contact providers and ask what they offer
About monthly, an EMS release occurs, and those clients with a sufficiently high priority score (usually 3 or higher) are released by DOEA (Department of Elder Affairs) in Tallahassee. No consideration of financial need or time in EMS is given. If a client does not score high enough, they could be in the EMS for a long period of time. If a client has been in the EMS for over a year, CARES should be calling to re-screen and get a more current Priority score. If there has been a documentable deterioration in their functional/medical the client’s score may be regenerated and may go up. If the client is on the list for over a year and does not hear from CARES, they should contact CARES and ask for the re-screen.
Avoid the EMS by using Nursing Home Transition Program
In order to qualify, a client must reside in a nursing home for 60+ days, be approved for ICP and meet all factors of eligibility for the Nursing Home Transition program.
If you have more questions regarding applying for the Nursing Home Diversion Waiver, any other Medicaid program or have questions regarding eligibility, please call the office and we will be happy to help.
[1] If Client is also interested in other services/ programs (Assisted Living Waiver, Aged and Disabled Adult Waiver), CARES will do an onsite assessment and refer for all programs desired. Client still enters EMS