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Miami is CareChoice’s newest market — and Florida’s Medicaid home care system works differently from Pennsylvania, Michigan, or Texas. If your family needs home care in the Miami area, this guide covers the program that funds it, the plans that administer it, and how to get services started.

Florida’s SMMC Long-Term Care Program

Home care in Miami is funded through the Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program, administered by Florida’s Agency for Health Care Administration(AHCA). SMMC LTC serves adults 18 and older who need long-term care services and are enrolled in Florida Medicaid.

Like Pennsylvania’s Community HealthChoices and Texas’s STAR+PLUS, SMMC LTC operates through managed care plans — private insurance companies that administer Medicaid benefits on behalf of the state. Your loved one is enrolled in a specific plan, and that plan manages their service authorizations, care coordination, and provider network.

In the Miami-Dade area, the primary SMMC LTC plans include Humana and Sunshine Health, among others. The plan your loved one is enrolled with controls the authorization process and connects you with home care providers.

What SMMC LTC Home Care Covers

SMMC LTC covers a comprehensive range of home and community-based services designed to keep individuals out of nursing facilities. Services include personal care assistance (bathing, dressing, grooming, toileting, eating, mobility), homemaker services (meal preparation, light housekeeping, laundry), companion and sitter services, adult day health care, home-delivered meals, personal emergency response systems (PERS), respite care for family caregivers, assistive care services, and skilled nursing visits when medically necessary.
For most Miami families, the core need is personal care — the daily hands-on help that allows a loved one to stay home safely. CareChoice provides this through our agency staff: trained, vetted home care aides who come to your loved one’s home on a regular schedule.

How Miami Differs from Our Other Markets

In Pennsylvania, Michigan, and Texas, CareChoice’s primary focus is helping families access paid family caregiving— programs where a relative is hired and paid as the caregiver. Miami operates differently.

In Florida, CareChoice primarily provides agency-directed home care— our staff delivers the care directly. Florida’s Medicaid system does include a Participant-Directed Option (PDO) that allows members to hire their own caregivers, and we accept PDO arrangements, but it’s important to understand a key Florida compliance rule: Florida Medicaid does not allow same-household members to serve as paid caregivers in most circumstances. This is different from Pennsylvania and Michigan, where living together is not a disqualifier.

This means the family caregiver model works differently in Miami. If a family member who lives separately from the care recipient wants to provide care through PDO, that may be possible. But the most common and straightforward path in Miami is agency-directed care through CareChoice’s own staff.

Who Qualifies for SMMC LTC in Miami

Your loved one may qualify if they are a Florida resident, enrolled in or eligible for Florida Medicaid, 18 years of age or older, and in need of a nursing-facility level of care as determined through a Comprehensive Assessment and Review for Long-Term Care Services (CARES)assessment.

The CARES assessment is Florida’s equivalent of the functional assessments used in other states. It evaluates your loved one’s ability to perform daily activities independently and determines whether they meet the nursing-facility threshold. The assessment is conducted by the state’s CARES program, not by the managed care plan.

Financial eligibility follows Florida Medicaid guidelines. Florida has not expanded Medicaid under the ACA, so eligibility categories are limited to individuals who are aged (65+), blind, or disabled, as well as SSI recipients. Florida also has an Institutional Care Program (ICP) Medicaid category specifically for individuals who need nursing-facility-level care.

How to Get Started in Miami

Step 1: Apply for Medicaid. If your loved one isn’t already enrolled, apply through the Florida Department of Children and Families (DCF) at myflorida.com/accessflorida, at a local DCF office in Miami-Dade County, or by calling 1-866-762-2237.

Step 2: Request a CARES Assessment. Once Medicaid is active (or simultaneously with the application), contact the CARES program to request a long-term care assessment. The CARES unit evaluates whether your loved one meets the nursing-facility level of care. Your local Aging and Disability Resource Center (ADRC) can also help initiate the CARES process — in Miami-Dade, the Alliance for Aging at (305) 670-6500 serves as the ADRC.

Step 3: Enroll in an SMMC LTC Plan. Once the CARES assessment confirms eligibility, your loved one is enrolled in an SMMC LTC managed care plan. They may choose a plan (Humana, Sunshine Health, etc.) or be auto-assigned.

Step 4: Develop a Care Plan. The plan assigns a case manager who conducts an in-home assessment and develops a care plan specifying services and hours.

Step 5: Begin Receiving Care. CareChoice begins providing home care services through our agency staff according to the authorized care plan.

In our experience getting established in the Miami market, the CARES assessment is the step that takes the longest — scheduling can take two to four weeks depending on demand. Starting the Medicaid application and CARES request simultaneously is the fastest approach.

CareChoice in Miami

CareChoice is building our Miami presence with the same commitment to family-centered care that drives our work in Philadelphia, Pittsburgh, Detroit, and Dallas. Whether your family needs agency-provided home care through SMMC LTC or wants to explore the Participant-Directed Option, our Miami team is here to help navigate Florida’s system.

Contact CareChoice → Miami team

Written by Gary Murray, Chief Marketing Officer | CareChoice