What to Do If You Cannot Afford Assisted Living in Florida, The Manors of Citrus

Illustration of an adult daughter and her father at a kitchen table sorting paperwork beside a phone and a list of numbers

In this article

Rule out Medicare first
Florida Medicaid does pay for assisted living
Optional State Supplementation
VA Aid and Attendance for veterans and surviving spouses
The policy nobody remembered
The house, family help, and what to ask
The order to try things in
Three questions worth asking every community

If your family cannot afford assisted living in Florida, the money almost always comes from one of five places: Florida Medicaid, the state's Optional State Supplementation payment, VA Aid and Attendance, a long term care insurance policy your parent may already own, or some mix of family help and home equity. The one thing that will not pay is Medicare, and learning that on day one instead of week three saves a lot of wasted effort.

Rule out Medicare first

Medicare does not cover custodial care, and custodial care is exactly what assisted living is: help with bathing, dressing, eating, walking and medications. Medicare itself says it does not cover this kind of long term care when that is the only care a person needs, and that it can be given at home, in the community, or in an assisted living facility, with the family paying. You can read what Medicare does not cover on medicare.gov.

Medicare still matters. It pays for the doctor, the hospital, the medications under Part D, and a limited stretch of skilled nursing or rehab after a qualifying hospital stay. It just never becomes the monthly source of payment for a residential community.

Florida Medicaid does pay for assisted living

Florida Medicaid covers assisted living services, not only nursing home care. That is worth knowing before you rule anything out.

Three state agencies each own a piece, which is why it feels slow:

The Agency for Health Care Administration runs the program and decides what it covers.
The Department of Elder Affairs decides medical eligibility, meaning whether a person needs the level of care a nursing home provides.
The Department of Children and Families decides financial eligibility, meaning income and assets.

You begin with a screening through your Aging and Disability Resource Center. The statewide Elder Helpline is (800) 963-5337. Ask them what the screening involves and how enrollment is working in your county right now. The call costs nothing, and starting it early can matter more than anything else you do this month.

Start the medical screening and the DCF financial application at the same time. They run on separate tracks at separate agencies, and families who wait to start one until the other finishes lose weeks for no reason.

Two of our posts go deeper on this: does Medicaid pay for assisted living in Florida and the Florida Medicaid long term care benefit explained.

There is one catch that no state agency will warn you about. A community chooses whether to accept Medicaid, and not every community in Citrus County does. So a family can win approval and still have nowhere nearby to use it. Sugarmill Manor in Homosassa and The Gardens in Crystal River both accept Florida Medicaid, and both offer assisted living and secured memory care in the same building, so a person does not have to move again if memory changes later.

See it for yourself

Sugarmill Manor: (352) 382-2531 The Gardens: (352) 794-7601

Optional State Supplementation

Optional State Supplementation, usually called OSS, is a separate Florida program and a common blind spot. The Department of Children and Families pays a monthly supplement to people with very low income who cannot live alone and who live in a state licensed assisted living community, adult family care home, or mental health residential treatment facility that accepts OSS.

It is not Medicaid, and applying for one does not apply you for the other, though DCF takes both applications. You can apply through the MyACCESS portal or by calling DCF at (866) 762-2237. Ask specifically whether the community you are considering accepts OSS, because participation is a choice each community makes.

VA Aid and Attendance for veterans and surviving spouses

If your parent served, or was married to someone who served, ask the VA about Aid and Attendance. It is not a separate check. It is an increased monthly amount added to a VA pension for a person who needs another individual's help with everyday activities like bathing, feeding and dressing, who is largely confined to bed, who is in a nursing home because of disability, or whose eyesight is severely limited.

Because it raises the pension amount, some people whose income was too high to qualify for a basic pension do qualify at the increased rate. A person cannot receive Aid and Attendance and the Housebound allowance at the same time. You can apply online, by mail to the VA Pension Intake Center, or in person at a regional office, and the VA general line is (800) 827-1000. Details are on the VA's Aid and Attendance page.

Part of the VA application has to be completed by a medical examiner, so book that appointment when you start the paperwork rather than after. Have the discharge record and marriage certificate ready too.

The policy nobody remembered

Go through the filing cabinet. Long term care insurance was sold heavily in Florida for decades, and a policy a parent stopped mentioning years ago may still be in the file. On the declarations page, look for three things: which settings it pays for, how long you have to pay out of pocket before benefits begin, and what has to be true medically for benefits to start.

If a policy lapsed by accident, do not assume it is gone. Florida rules give some policyholders a window to reinstate a policy that was cancelled unintentionally when the person has since been diagnosed with a cognitive impairment or a loss of functional capacity. Call the insurer, ask about reinstatement, and ask how long the window lasts before you write the policy off. The Florida Department of Financial Services publishes a plain language long term care insurance guide for consumers.

The house, family help, and what to ask

Home equity is usually the piece to think through most slowly. Selling ends the taxes, the insurance and the repairs, but it converts a protected asset into countable money, which can change a Medicaid answer. Renting keeps the house but creates income and a landlord's headaches. If a spouse still lives there, the rules differ again. Do not guess: ask DCF how the house is treated in your parent's exact situation.

Family contribution works best when it is specific and short term. Three siblings covering a set share until a Medicaid decision arrives is a plan. An open ended promise usually is not.

The order to try things in

Step	Who to call	What it settles
Confirm Medicare will not pay	The plan on the card, or medicare.gov	Ends the most common misunderstanding
Medicaid medical screening	Elder Helpline (800) 963-5337	Whether the level of care qualifies
Medicaid financial application	DCF (866) 762-2237	Income and assets
Optional State Supplementation	DCF, same phone number	A monthly supplement toward a licensed community
VA Aid and Attendance	VA (800) 827-1000	An increased pension for a veteran or surviving spouse
Long term care policy	The insurer named on the policy	What it pays, and when it starts

Work down that list in order, and start the top three in the same week.

Three questions worth asking every community

Our guide to assisted living in Citrus County lists every licensed community in the county, including which ones accept Medicaid, so you can see the local picture in one place. When you call any of them, ask these three things.

Ask whether the community accepts Florida Medicaid, and whether that applies to someone already living there or only to a new resident. Ask whether it accepts OSS. Then ask what happens if a resident's money runs out while living there. The honest answers vary a lot, and it is far better to hear them now than in two years.

Frequently asked questions

What happens if my mom runs out of money in an assisted living community in Florida?

She may qualify for Florida Medicaid, which does pay for assisted living, or for Optional State Supplementation through the Department of Children and Families. The catch is that the community itself has to accept those payments, so ask before she moves in rather than after.

Does Florida Medicaid pay for assisted living?

Yes. Florida Medicaid covers assisted living services for people who need the level of care a nursing home provides and who meet the financial rules set by the Department of Children and Families. Start with a screening through the Elder Helpline at (800) 963-5337.

Does Medicare pay for assisted living?

No. Medicare does not cover custodial care, which is the daily help with bathing, dressing and medications that assisted living provides. Medicare still pays for doctors, hospital stays and a limited stretch of skilled rehab.

Can a veteran or a surviving spouse get help paying for assisted living?

Often, yes. A veteran or the surviving spouse of a veteran with wartime service may qualify for a VA pension, and the Aid and Attendance allowance increases that monthly amount for someone who needs help with everyday activities. Call the VA at (800) 827-1000.

Which assisted living communities in Citrus County accept Medicaid?

Not all of them do. Sugarmill Manor in Homosassa and The Gardens in Crystal River both accept Florida Medicaid, and both offer assisted living and secured memory care in the same building.

Sources

Written by

Cameron Hernando Clark

Community Relations Director

Cameron Hernando Clark is the Community Relations Director for The Manors of Citrus. He writes this family guide to help Citrus County families make sense of assisted living and memory care, drawing on the day to day of running two family owned communities on Florida's Nature Coast.