But Greg Mellowe, policy director for the patient-advocacy group Florida CHAIN, said it would be harder for the state to get approval of the broader managed-care proposal. That proposal would build off a highly controversial Medicaid managed-care pilot program that operates in five counties.

“The fact that the managed long-term care waiver was approved in no way indicates that approval of the broader statewide Medicaid managed-care waiver can be justified or will be forthcoming,” Mellowe, whose group has been highly critical of the managed-care proposal, wrote in an email.

The state Agency for Health Care Administration has already gone through a lengthy contracting process to choose health plans that would provide long-term care services to seniors. That process involved competitive bidding in 11 regions of the state and led to AHCA awarding contracts to American Eldercare, Sunshine State Health Plan, United HealthCare of Florida, Coventry Health Care of Florida and Amerigroup Florida.

AHCA hopes to start using the new long-term care system as early as August in the Orlando area and gradually move into other areas of the state. But enrollment could be delayed in three regions — the western Panhandle, the Big Bend and Palm Beach County and the Treasure Coast — because of protests by losing bidders.

The Centers for Medicare & Medicaid Services sent a letter to the state on Friday, approving the long-term care changes effective July 1. The approval is for three years, expiring June 30, 2016, with the state able to request renewals “by providing evidence and documentation of satisfactory performance and oversight.”

Michael Garner, president of the Florida Association of Health Plans, said moving to the long-term care system would require an extensive education effort for seniors and family members who will choose between managed-care plans. Like Negron, Garner said nursing homes will continue to play an important role, but said he hopes the new system will help get people into the “lowest-cost settings that are preferable for them and their families.”