The CARES Assessment in Florida: How Nursing Home Level of Care Gets Decided (2026 Guide)

By Jacksonville Senior Advisor Care Team · August 5, 2026

What the CARES assessment is and why it stands between your family and Medicaid long-term care

If you have started looking into Medicaid help for a parent in Jacksonville, you have probably run into the phrase CARES assessment and gotten very little explanation of what it actually is. CARES stands for Comprehensive Assessment and Review for Long-Term Care Services, and it is administered by the Florida Department of Elder Affairs. It is the clinical half of a two-part gate. The financial half is handled by the Department of Children and Families, which looks at income and assets. CARES looks at the person. Its job is to determine whether your family member medically meets what Florida calls nursing facility level of care. Without that determination, no amount of financial eligibility will unlock Medicaid-funded nursing home care or a spot in the Statewide Medicaid Managed Care Long-Term Care program. Families in Duval, Clay, St. Johns, Nassau, and Baker counties all route through this same statewide process, even though the local hospital, the local Aging and Disability Resource Center, and the plan you eventually enroll with are all Northeast Florida organizations.

The part that surprises most families is that CARES is not a formality and it is not a rubber stamp on a doctor's note. A CARES assessor, typically a registered nurse or a trained assessor working with a physician reviewer, does an independent evaluation. A cardiologist at Baptist can write that your mother needs skilled care, and CARES can still reach a different conclusion about level of care, because the two are answering different questions. The doctor is describing a diagnosis. CARES is measuring function, supervision needs, and what happens without help. Understanding that distinction early saves an enormous amount of frustration later.

The three ways a Jacksonville family usually ends up in the CARES queue

The first and most common path is a hospital discharge. A parent falls, spends four days at Baptist Medical Center Jacksonville, UF Health Jacksonville, Ascension St. Vincent's, or Orange Park Medical Center, and the discharge planner raises the possibility of a nursing facility. If Medicaid is going to be the payer, a CARES referral gets made from the hospital or from the receiving facility. This route tends to move fastest because the clinical documentation is fresh, thorough, and already in the record. The second path starts at home. A family calls the ElderSource Elder Helpline at 1-888-242-4464 or (904) 391-6699 and gets screened for long-term care services. That screening produces a priority score, and when a slot opens, a CARES assessment is scheduled. The third path is a person already living in a nursing facility on private pay whose money has run out and who is now converting to Medicaid.

The path matters because it determines your realistic timeline and where your energy should go. The hospital route often produces a determination within days. The community route, where a family is trying to get Medicaid long-term care services for someone still living in Mandarin or Orange Park, is the slow one, because it involves both an initial screening and a wait for release from the statewide queue. Families who assume all three paths move at the same speed frequently make a placement decision on a timeline that Medicaid will not match, and end up privately paying for months they had not budgeted.

What the assessor actually looks at during the visit

The CARES evaluation is functional, not diagnostic. The assessor is building a picture of what your family member can and cannot do without another person present. Activities of daily living carry the most weight: bathing, dressing, toileting, transferring from bed to chair, walking, and eating. So do instrumental activities like managing medications, handling money, and using a phone. The assessor asks about incontinence, about falls in the last several months, about wandering, about whether the stove has been left on, about whether medication is being taken as prescribed. For someone with Alzheimer's or another dementia, the supervision question often carries the determination more than any physical limitation does, because a person who is physically capable but cannot be left alone safely has a genuine level-of-care need. The assessor also reviews medical records, current medications, and any skilled nursing or therapy needs such as wound care, injections, or tube feeding.

Two things trip families up here. The first is what geriatric clinicians sometimes call showtiming: an older adult who rallies for company, answers every question crisply, and insists they cook their own dinner every night. That is not dishonesty, it is a lifetime of social habit, and it can produce an assessment that reflects a very good hour rather than a typical week. The second is the caregiver who answers on their parent's behalf out of politeness and understates how much they are actually doing. If you have been driving over from Fleming Island twice a day to manage medications, say exactly that. Keep a two-week log before the visit noting falls, missed medications, incontinence episodes, nighttime waking, and how many hours of hands-on help you personally provided. Concrete specifics are far more useful to an assessor than the phrase she needs a lot of help.

Reading the determination, and what it unlocks

The outcome you are hoping for in most cases is a finding that the person meets nursing facility level of care. That finding is what makes someone clinically eligible for Medicaid-funded nursing home care and, importantly, for the Statewide Medicaid Managed Care Long-Term Care program, which is Florida's route to receiving long-term care services outside a nursing home. Once financially and clinically eligible and enrolled, a person chooses among the SMMC LTC plans operating in the region, which include Sunshine Health, Humana, Simply Healthcare, UnitedHealthcare Community Plan, Aetna Better Health, Florida Community Care, and Molina. The plan then assigns a case manager who develops the care plan and authorizes services. A CARES determination may also come back as intermediate or with a recommendation for a less intensive setting or for home and community based services rather than institutional placement.

It is worth being precise about what the determination does not do, because this is where hope and reality diverge most painfully. Meeting level of care does not by itself mean services start next week. It does not mean Florida Medicaid will pay the room-and-board portion of an assisted living community's monthly rate, because Florida Medicaid does not cover room and board in an ALF; the SMMC LTC program can cover certain services delivered in an assisted living setting for enrolled members, but the residential charge remains a private-pay obligation. In practical terms, a family in Jacksonville facing assisted living rates of roughly $3,200 to $5,500 a month should not plan around Medicaid absorbing that rent. And a level-of-care finding does nothing about the financial side, which runs on its own track through DCF and has its own income and asset rules that change annually.

When the determination does not match what you are living with at home

Sometimes CARES concludes that a person does not meet nursing facility level of care, and the family reading that letter cannot reconcile it with the parent they are managing around the clock. This happens most often with early to moderate dementia, where physical function is largely intact and the actual need is supervision, cueing, and safety. It also happens when the assessment captured an unusually good day, or when a hospitalization's documentation focused on the acute event and never described baseline function. A denial is not the end of the process. Florida provides an appeal route, and the notice you receive will state the specific deadline and method for requesting a hearing. Those deadlines are short and they are enforced, so the date on that letter is the first thing to write down.

Before or alongside an appeal, gather what the original assessment did not have. A letter from the treating physician or the neurologist that describes function and supervision needs rather than diagnosis alone carries real weight. So do cognitive testing results, home health notes, a fall log, and a written statement from you describing a typical twenty-four hours in specific detail. If the person's condition has changed since the visit, a reassessment may be the better route than an appeal. Two local resources are worth using without hesitation: the ElderSource Elder Helpline for guidance on the process and on interim services, and the Florida Long-Term Care Ombudsman Program if the person is already residing in a licensed facility and the concern involves resident rights. Families with the means to do so also frequently consult a Florida elder law attorney, since the clinical and financial tracks interact in ways that are difficult to navigate cold.

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Common questions

How long does a CARES assessment take, and what should our family have ready before the assessor arrives?

The visit itself typically runs somewhere in the range of an hour, though it varies with the person's condition and how much record review is needed. What you can control is preparation. Have the current medication list with dosages, contact information for the primary care physician and any specialists, recent hospital discharge paperwork from Baptist, Mayo, UF Health, Ascension St. Vincent's, or wherever care was delivered, and any cognitive testing results. Bring a written log covering the previous two weeks that documents falls, incontinence episodes, missed or doubled medications, nighttime waking, wandering, and the hours of hands-on assistance a family member actually provided. Have the person who does the day-to-day caregiving present, not just whoever is available. Concrete, dated examples are far more persuasive than general characterizations, and they protect against an assessment that captures an atypically good hour.

Does a CARES assessment mean Florida Medicaid will pay for my parent's assisted living in Jacksonville?

Not in the way most families expect. Meeting nursing facility level of care through CARES is what makes a person clinically eligible for the Statewide Medicaid Managed Care Long-Term Care program, and that program can cover certain services delivered to an enrolled member living in an assisted living community. It does not cover room and board in an ALF. The residential charge, which in the Jacksonville metro commonly falls between roughly $3,200 and $5,500 a month and runs higher at the Beaches and in St. Johns County, remains a private-pay responsibility funded from the resident's income, savings, family contributions, a long-term care insurance policy, or veterans benefits such as Aid and Attendance. The community must also participate with the specific SMMC LTC plan, which is a question to ask the community directly, in writing, before signing anything.

Can we request a CARES assessment while my mother is still admitted at Baptist or UF Health Jacksonville?

Yes, and doing so is usually the faster path. Ask to speak with the case manager or discharge planner as early in the admission as possible, tell them plainly that Medicaid will be the expected payer for long-term care, and ask that a CARES referral be initiated before discharge. Hospital-initiated referrals move more quickly than community referrals for a simple reason: the clinical documentation is current, detailed, and already assembled in one place. If your mother is heading to a skilled nursing facility for a Medicare-covered rehabilitation stay first, raise the question anyway, because that benefit is time-limited and the transition to long-term care coverage needs to be underway well before it ends. Do not wait for the hospital to bring it up. Discharge planning moves fast and Medicaid is often not the assumption.

What happens if CARES decides my parent does not meet nursing facility level of care?

You receive a written notice, and that notice states the specific appeal deadline and the process for requesting a hearing. Read it the day it arrives and calendar the deadline, because these windows are short and strictly applied. Then decide between two routes. If you believe the assessment simply missed the reality, appeal and supply what was absent: a physician letter describing function and supervision needs rather than diagnosis alone, cognitive testing, home health notes, a fall and incident log, and your own detailed account of a typical day. If the person's condition has genuinely worsened since the visit, a reassessment may be the more appropriate request. Meanwhile, call the ElderSource Elder Helpline at 1-888-242-4464 or (904) 391-6699 about interim services, since supports such as respite, home-delivered meals, and caregiver assistance may be available independently of a nursing facility level-of-care finding.