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Long-Term Care a Lifeline for Poor

Milagros Medina rents a room in a quiet subdivision on the outskirts of Lakeland. At 68, her arthritis, high blood pressure and chronic back pain are not going away. 

And she doesn’t want to end up in a nursing home.

This retiree who likes being called Miss Millie tries to keep going by getting help with the chores most people take for granted. She says without financial help from Florida’s Medicaid program, she couldn’t afford it. And her health would suffer.

“A lot of people don’t get the care that they need,” she said. “I am very grateful to one of my doctors for looking into the system and helping me.”

The system she mentions is Medicaid's Long-Term Care program. It serves more than 48,000 of Florida's frailest residents who cannot live independently, but may not need around-the-clock medical care.

Many of these low-income Floridians live in nursing homes and assisted living facilities. Others stay home, but need help with the basics of daily living.

Miss Millie needs help showering and cooking, especially when her arthritis keeps her from gripping a pot handle or a cup. She struggles to get much done on days her home health aide doesn't stop by. Her caregiver, Chaz Idleburg, is more modest.

“I come three times a week. And I help her with the laundry, folding, ironing,  sweeping, mopping, dusting, making beds, grocery shopping,” Idleburg said. “It’s basically what you would do at home.”

Idelburg's assistance is what government agencies call "custodial" care. Medicaid Long-Term Care covers non-clinical health issues while doctor appointments and hospital stays are medical in nature. And for seniors 65 and over, that's the stuff covered by the separate Medicare health insurance program.

There are limits as to who qualifies for Medicaid assistance. Residents with gross incomes above $2,100 a month or just over $25,000 dollars a year are out. And detailed rules decide the size and kinds of assets that Medicaid-eligible residents or their spouses can keep.

Still, Florida has a significant waiting list. In December, the roster was more than 39,000 names deep.

The demand also comes at a critical time for Medicaid. The Agency for Health Care Administration is in the final phases of transferring program management to private contractors. Last week, the Tampa Bay area became the fifth region in the state to switch over. The final regions, in North Central Florida, Duval County and the western Panhandle, finish the rollout on March 1.

This managed care model means private plans will now distribute Medicaid money to facilities and other providers. Agency officials say plans can better coordinate services for participants as well as save taxpayer money.

The state expected glitches, so it insists plans pay providers within 10 days or face penalties. And the plans can't be picky. This year, they must work with any provider or facility that already helps people in the long-term care program.

Justin Senior, the state's Deputy Secretary for Medicaid, said the top priority is on making sure residents don't lose any services.

"It’s really imperative that the services that person is receiving in the weeks and months before the rollout on a daily basis are the same as the services they are receiving on day one of the roll out and in the weeks and the months after the rollout," he said.

Elder law attorney Emma Hemness says she's hearing about some facilities getting smaller Medicaid payments, now that managed care plans are running the show. Hemness, a founder of the Foundation for Long-Term Care Solutions, said residents may have to pay more from what little money they have, or consider moving.

Private plans have financial incentives to save money, especially when they move more people out of nursing homes. The Brandon lawyer says not everyone is healthy enough to move into assisted living or a home-based setting.

“We as senior advocates, we have always said we’re very concerned with the cutting of the quality of services, the cutting of the quantity of services," she said.

Senior says rules are in place to give participants control over their care. For example, any enrollee can change their plan within three months of signing up.

"Once someone chooses a plan, they have an additional 90 days to in essence 'kick the tires' on that plan and try it out and can switch plans during that 90-day period for any reason: good reason, bad reason, no reason at all," Senior said.

Right now, Miss Millie is happy because her plan includes Chaz's company. She says the help around the house and rides to church that the young woman provides help her body and spirit.

"Through her, I am more in touch with other human beings feelings and what is going on in their lives,” she said.

For Miss Millie, that's a kind of care money cannot buy.

--Health News Florida is part of WUSF Public Media. Contact Reporter Mary Shedden can at (813) 974-8636, on Twitter @MaryShedden, or email at For more health news, visit

Mary Shedden is news director at WUSF.