Senior living industry experts are calling Florida’s $117 billion state budget a mix of hits and misses regarding programs supporting older adults.

Increasing the Medicaid reimbursement rate and personal needs allowance were two wins state associations are celebrating.

The 2024-2025 state budget, which was passed recently by lawmakers at the end of the 2024 legislation session, included a $1.3 million Medicaid increase for Assistive Care Services, which includes services provided by assisted living communities. 

“We are immensely grateful to the legislature and their collaborative efforts that resulted in a budget that not only addresses immediate needs, but also builds upon a solid foundation for the future of elder care in our state,” LeadingAge Southeast Vice President of Advocacy Susan Langston said in a statement. “From nursing homes, assisted living facilities, home- and community-based services, to affordable senior housing and workforce, these investments reflect a commitment to sustaining programs and services that provide high quality care for Florida’s older adults as they age across the continuum.”

Florida Assisted Living Association CEO Bijou Ikli explained that the ACS increase will help offset some of the costs associated with providing care for low-income residents. That daily rate had been $13.37, which Ikli said wouldn’t cover an hour of child care or even boarding for a pet, let alone coverage for assisting an older adult with activities of daily living. The latest budget increase will bump that daily rate by 15%.

The low reimbursement rate previously led many assisted living providers to forgo acceptance of ACS residents. Ikli said that  a bump in the rate might incentivize others to accept this type of reimbursement and potentially reduce instances of earlier transitions of residents to skilled nursing facilities.

The Florida Senior Living Association said it supported the rate increase.

“Consistent Medicaid increases are necessary for the future of assisted living,” Jason Hand, FSLA vice president of public policy and legal affairs, told McKnight’s Senior Living. “Each assisted living community in Florida is unique and provides many types of services, and we are grateful for every investment made toward securing the continued future of our amazing communities and their residents.”

Increasing the personal needs allowance

The budget also includes $6.7 million to increase the personal needs allowance for individuals receiving Florida Optional State Supplementation in an assisted living community, adult family care home or mental health treatment center. The OSS program helps qualified low-income individuals pay for room and board in those settings. 

Ikli said that the increase is a significant win, as the personal needs allowance — which allows residents to retain a portion of their personal income to pay for personal expenses such as haircuts, toiletries, clothing and snacks — has remained $54 per month for assisted living residents for the past 20 years. The state budget increase brings that monthly figure up to $160 to match the amount nursing homes residents receive. 

“We thought it was important to address, because we thought it must be an oversight,” Ikli said, adding that many assisted living providers who choose to supplement their residents’ needs faced the prospect of going out of business because they couldn’t maintain those expenses.

Assisted living part of ‘promising’ discussions

One area that didn’t gain traction in the latest legislative session was addressing the statewide Medicaid managed care long-term care wait list, or SMMC-LTC. 

Individuals are living longer, so many older adults who move into private-pay assisted living are running out of money and have to go through the process of applying for long-term care managed care. Those individuals eventually are placed on the SMMC-LTC waitlist for the communities they once called home.

Ikli said that the system creates a level of unnecessary stress and disruption for residents. Although proposals to rework the system did not make it to the committee level, she said that “promising” conversations have occurred about developing a plan to discuss the issue in a rules setting.

In addition, there also is an effort in the state to free up beds in skilled nursing facilities by transitioning more individuals into the greater community by identifying community-based alternatives. Ikli said that she is excited about that effort and believes it presents an opportunity for assisted living providers to help with some of those transitions. 

“There is a lot of room for assisted living to help with saving the system a lot of money, especially for individuals who can’t be alone but also don’t need 24-hour nursing care, to have a place to go,” she said. 

The key to being successful, she said, is going to be demonstrating the value of assisted living. Ikli said that the sector needs to be able to document its value, show the benefit and work as collaborative partners with various agencies and provider types on the healthcare continuum.