Florida's Statewide Medicaid Managed Care Long-Term Care program is one of the most complex state structures in the country. Three separate state agencies each own a different piece of eligibility. Nine geographic regions each have different plan options. SMMC 3.0 launched February 1, 2025, with new contracts and new plan configurations through 2030. And the program has a waitlist for home and community-based services — which shapes how agencies must manage their referral pipeline. Here is the operational picture for Florida home care operators.
Florida's SMMC LTC program is unusual in that three state agencies each manage a distinct piece of the eligibility determination. Understanding who does what prevents wasted time chasing the wrong agency when a client's application stalls.
For applicants not in a nursing home, the process starts with a phone screening through the ADRC (Aging and Disability Resource Center) or the Elder Helpline at 1-800-963-5337. A screening score determines priority for the waitlist. When space becomes available, CARES conducts the in-home assessment. Applicants with low priority scores are not placed on the waitlist at all.
The SMMC LTC program covers long-term care services only — not medical care, doctor visits, or hospital stays. Medical benefits are covered under the separate SMMC Managed Medical Assistance program. Members enrolled in both LTC and MMA have both programs active simultaneously, with different plans managing each component.
February 1, 2025 — SMMC 3.0 launched. New 2025-2030 contracts took effect. Florida reorganized from 11 regions to 9 regions. Plan configurations changed — not all plans from the prior 2018-2024 period continued in all regions, and some new plan types were introduced. Providers needed to re-verify their network status with plans under the new contract terms.
LTC plans vary by region. The following are among the LTC-contracted plans operating under SMMC 3.0, though not all are available in all 9 regions. Verify plan availability in your specific region through AHCA's SMMC plan comparison tool at flmedicaidmanagedcare.com before credentialing.
| Plan | Geographic Presence | Notes |
|---|---|---|
| Florida Community Care (FCC) | All 9 regions — statewide | LTC-only plan (not MMA). Also the sole ICMC plan for the DD population. Statewide footprint makes it a primary credentialing target for most agencies. |
| Humana Medical Plan | All 9 regions — statewide | Comprehensive plan (MMA + LTC). Large statewide presence. |
| Aetna Better Health of Florida | Select regions (verify with AHCA) | Comprehensive plan. Not present in all 9 regions. |
| Simply Healthcare Plans | Select regions | Comprehensive plan operating in certain regions including Central Florida. |
| Sunshine State Health Plan (Centene) | Multiple regions | Comprehensive plan. Centene subsidiary. |
| AmeriHealth Caritas Florida | Select regions | Comprehensive plan. Regional presence varies. |
| Molina Healthcare of Florida | Miami-Dade and Monroe counties (Region 11) | Limited regional presence. Currently only in southernmost region for LTC. |
Members select a plan from the options available in their region. If they do not choose, AHCA assigns one. Providers must be credentialed with the member's specific LTC plan to bill for services. Being credentialed with FCC does not give you standing with Humana for LTC — each is a separate credentialing process.
The SMMC LTC program has a waitlist for home and community-based services. CARES priority scoring determines who gets placed on the waitlist and in what order. Applicants who score below the threshold are not waitlisted and will not receive HCBS services — only nursing facility placement if they eventually need it. This waitlist dynamic means your referral pipeline from ADRC contacts and care coordinators requires active management. Members with higher CARES priority scores move faster. Members with lower scores may wait indefinitely.
Nursing home services under SMMC LTC do not face the same waitlist constraints — individuals requiring institutional care can generally access that pathway more quickly once they meet financial and clinical eligibility.
EVV requirements for SMMC LTC home care services flow through the LTC plan's EVV expectations — each plan contracts with EVV vendors or may use their own EVV infrastructure. Verify EVV requirements with each LTC plan you contract with, as these vary. There is no single statewide EVV aggregator with the same role as HHAeXchange in Texas or LaSRS in Louisiana.
You must enroll with AHCA as a Florida Medicaid provider to receive a provider ID. This is the prerequisite for LTC plan credentialing. After AHCA enrollment, credential separately with each LTC plan operating in your region. Plans contact is available through AHCA's provider relations directory and through the plan websites directly.
Florida's licensing requirements for home health and companion/homemaker agencies are managed by AHCA's division of facility regulation. Verify which license type applies to your service model before enrollment.
The iBudget Waiver serves individuals with developmental disabilities — a separate program from SMMC LTC. Florida Community Care (FCC) is the sole statewide plan for the ICMC (Intellectual and Developmental Disabilities Comprehensive Managed Care) pilot, with expansion to all DD Medicaid-eligible individuals planned for July 2026.
Agencies serving the DD population need separate enrollment through the Agency for Persons with Disabilities (APD) and credentialing with FCC for ICMC. This is a distinct operational track from standard SMMC LTC.
SMMC LTC is Florida's Medicaid managed long-term care program for adults 18+ who need nursing facility level of care. AHCA administers the program, DOEA/CARES determines medical eligibility, and DCF determines financial eligibility. The program has a waitlist for home and community-based services — capacity is limited, and CARES priority scores determine who gets placed on the waitlist and in what order. Nursing facility services through the program are not subject to the same waitlist constraints. SMMC 3.0 launched February 1, 2025, with new contracts through 2030 and Florida reorganized into 9 regions.
Start with the plans present in your specific region. Florida Community Care (FCC) and Humana Medical Plan are the only plans with full statewide footprints across all 9 regions. Other plans — Aetna, Simply Healthcare, Sunshine State, AmeriHealth Caritas — operate in select regions. Molina currently operates LTC only in Miami-Dade and Monroe counties. Use AHCA's plan comparison tool at flmedicaidmanagedcare.com to identify exactly which plans are available in each county of your service area, then credential with all plans operating there. A member can only be billed through their specific LTC plan.
CARES (Comprehensive Assessment and Review for Long-Term Care Services) is the DOEA program that conducts in-home assessments to determine whether an SMMC LTC applicant meets nursing facility level of care. CARES staff assign a priority score. That score determines whether the applicant is placed on the HCBS waitlist and where. Applicants below a priority threshold are not waitlisted. Knowing a client's CARES priority score — and what it means for their timeline — helps you manage intake expectations accurately. CARES is your operational signal for when a referred client will realistically be able to begin receiving services.
Florida agencies managing SMMC 3.0 plan credentialing across multiple regions, CARES waitlist tracking, plan-specific EVV compliance, and AHCA enrollment are running significant simultaneous administrative complexity. CareBravo delivers scheduling, EVV compliance, authorization tracking, and LTC plan billing as completed operational work.