Florida Medicaid: The Medicaid Project, Florida Medicaid Eligibility, Programs, Requirements

Topics on this page:

Florida Medicaid Insurance definition, About Medicaid
What Is Medicaid in Florida?
Medicaid Eligibility, Requirements, Income Limits
Citizenship Requirements
Applying for Medicaid
Medicaid Area Offices
Health Plans, HMO's
Find Medicaid Physicians, Doctors
Health Programs for Children: CHIP: Florida

Medicaid Benefits and Coverage
Medicaid Prescription Drugs; Preferred Drug List
Medicaid Dental Services
Other Health Coverage Options in Florida
Florida Medicaid and Nursing Homes, Assisted Living, Home Health Care
Florida Medicare / Medicaid Dual Eligibles - Florida Medicare Savings Program
Florida Medicaid Waiver Programs
Report Medicaid Fraud

About Medicaid Insurance in Florida*: "Medicaid is the state and federal partnership that provides health coverage for selected categories of people with low incomes. Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children. Medicaid is different in every state.

In Florida, the Agency for Health Care Administration (AHCA) develops and carries out policies related to the Medicaid program. "
*source: Florida Agency for Health Care Administration, Tallahassee, FL 32308

Florida Children’s Medicaid and Children's Health Insurance Program:: "Florida KidCare provides low or no-cost health insurance for children from birth through age 18 whose family incomes are too low to afford health insurance coverage for their children, but whose incomes are too high to be eligible for Medicaid. Florida KidCare consists of four programs: Children’s Medicaid, MediKids, Healthy Kids, and Children’s Medical Services."
*source: The Florida Legislature, (Florida) Office of Program Policy Analysis and Government Accountability, Tallahassee, Florida 32399-1475

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Medicaid in Florida: How It Works; An Introduction to Florida Medicaid; What is Florida Medicaid?

web page:
Florida Medicaid - A Reference Guide

source: Florida Agency for Health Care Administration
languages: English
from the web page:
"...Many Medicaid beneficiaries in Florida are enrolled in some form of health plan, which includes MediPass, health maintenance organizations, provider service networks, and local provider organizations. Individuals choose among the health plans available in their area of the state and see health care providers who are a part of the plan. "
web page:
MEDICAID | Florida

source:healthinsuranceinfo.net - Georgetown University's Health Policy Institute
languages: English
from the webpage:
"...In Florida you may be eligible for Medicaid if you are an infant, a child, pregnant, the parent of a dependent child, medically needy, elderly, or disabled, and your family income meets the Medicaid income standard..."
web page:
Key Medicaid Information for Florida for 2010

source:Elder Law Answers
languages: English
Explains important basics about Florida Medicaid. Topics include protections for the community spouse, transfers, income, and estate recovery...

web page:
About Medicaid Reform

source:Florida's Medicaid Reform Choice Counseling Website
languages: English

from the webpage:
"Medicaid Reform is Florida's new health care program for Medicaid beneficiaries that will increase choice and offer more services for you and your family..."
brochure:
Understanding Florida’s Medicaid Reform Legislation (2005)

source:Winter Park Health Foundation
file size: 7 pg. languages: English
Examines the legislation which relates to the Medicaid “Empowered Care” Section 1115 waiver. ...
web page:
Florida & United States State Medicaid Fact Sheets

source:Kaiser Family Foundation
file size: languages: English
web page:
Florida Medicaid

source:GovBenefits.gov - Your Benefits Connection
languages: English
from the web page:
"Florida Medicaid is the state and Federal partnership that provides health coverage for selected categories of people in Florida with low incomes. Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children...."

Florida Medicaid Eligibility, Requirements; Medicaid Income Limits

web page:
ACCESS Florida Food, Medical Assistance and Cash - Medicaid

source:Florida Department of Children and Families (DCF)
languages: English
from the web page:
"Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients)....."
- also from Florida Department of Children and Families (DCF):
  web page:
  Medicaid eligibility in Florida
  languages: English
  
  from the publication:
  "DCF determines Medicaid eligibility for: Low income families with children; Children only; Pregnant women; Non-citizens with medical emergencies; Aged and/or disabled individuals not currently receiving Supplemental Security Income (SSI)..."
- brochure:
  Family-Related Medicaid Income & Asset Limit Chart
  1 page; languages: English
  
  from the publication:
  "DCF determines Medicaid eligibility for: Low income families with children; Children only; Pregnant women; Non-citizens with medical emergencies; Aged and/or disabled individuals not currently receiving Supplemental Security Income (SSI)..."
web page:
Eligibility for Medicaid Services (Florida)

source:Florida Agency For Health Care Administration
languages: English
from the web page:
"Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients)..."
brochure or publication:
The Medicaid Eligibility Maze: Coverage Expands, but Enrollment Problems Persist - Findings from a Five-State Study

source: Urban Institute
file size: 56 pg. languages: English
from the brochure:
"This report examines Medicaid eligibility policies and operations in five states— California, Colorado, Florida, Minnesota, and Wisconsin—following initial changes introduced by PRWORA and the new Children's Health Insurance Program (CHIP), which was part of the Balanced Budget Act of 1997..."
web page:
Medicaid Eligibility

source: Centers for Medicare & Medicaid Services
languages: English
Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
web page:
2011 HHS Poverty Guidelines

source: Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
languages: English
from the web page:
"...The poverty thresholds are the original version of the federal poverty measure... The poverty guidelines are the other version of the federal poverty measure.

Medicaid Citizenship Requirements

web page:
New Citizenship and Identity Requirements Have Taken Effect

source:Florida Healthy Kids
languages: English, Spanish
from the web page:
"All new or renewing Florida KidCare enrollees must provide proof of citizenship and identity. But don’t worry – your existing coverage will not be cancelled if you don’t have the documents on hand right now. This applies only to new or renewing families..."
brochure:
Citizenship Documentation Requirements in Medicaid

source:Kaiser Family Foundation
3 pages; languages: English
from the publication:
"Medicaid citizenship requirements Under federal law, all U.S. citizens and certain legal immigrants who meet Medicaid’s financial and non-financial eligibility criteria are entitled to Medicaid. The Medicaid program has long required states to establish that individuals applying for Medicaid are U.S. citizens or satisfy the immigration restrictions.... "
brochure:
Medicaid Citizenship Verification Requirement

source:American Public Human Services Association
5 pages; languages: English
from the publication:
"What has changed? In the Deficit Reduction Act of 2005, a new requirement was established with respect to citizenship verification of current and new Medicaid applicants. Citizen applicants were previously able to self-attest their citizenship and identity under penalty of perjury to qualify for Medicaid..... "

Applying for Medicaid

website:
ACCESS Florida - Automated Community Connection to Economic Self-Sufficiency
web page:
How do I apply? (Florida Healthy Kids and KidCare)

source:Florida Healthy Kids
languages: English, Spanish
from the web page: "...Healthy Kids and KidCare now has year round open enrollment! Applying is easy! It takes 4-6 weeks to process a complete application. Coverage only begins after your child's eligibility has been determined and the first month's premium has been received, if required..."

Versión en Español: ¿Cómo aplicar?

Florida Medicaid Area Offices

web page:
Medicaid Area Offices

source:Florida Agency for Health Care Administration
languages: English, Spanish
from the web page:
"Medicaid has eleven area offices located throughout the state that represent a dynamic blend of divergent geographic, cultural, social and economic factors and conditions. They range in size from one county to 16 and serve more than 2.4 million Medicaid beneficiaries..."

Medicaid Health Plans, HMO

web page:
Step 1: Choose your Plan

source:Medicaid Options
file size: 45 pg.; languages: English
from the brochure:
"...You must choose your plan within 30 days. If you do not, the State will choose a plan for you. If your doctor does not work with this plan, you will have to choose a new doctor.

Florida Medicaid has the following types of health care plans:
Health Maintenance Organizations (HMOs)...
MediPass is a statewide provider network run by Florida Medicaid...
Provider Service Networks (PSNs) are run by a network of doctors and hospitals... ..."
notice:
Patient Rights and Responsibilities

source:Florida Agency For Health Care Administration
languages: English
from the notice:
"Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care and that you respect the health care provider’s or health care facility’s right to expect certain behavior on the part of patients. You may request a copy of the full text of this law from your health care provider or health care facility.... "

Find Medicaid Physicians, Doctors

web page:
Find Medicaid Doctors, Dentists, and Specialists

source:Florida Agency for Health Care Administration
languages: English, Spanish
from the web page: "To find doctors, dentists, and specialists in your community that serve Medicaid patients, click ..."

Children's Medicaid: Health Programs for Children: CHIP: Florida

What is Medicaid for children in Florida?

What is Florida KidCare?: "Florida KidCare is the State of Florida’s high-quality, low-cost health insurance for children. The program was created through Title XXI of the Social Security Act and reauthorized in 2009. Through its four partners, including Florida Healthy Kids, the program covers children from birth through age 18:"
source: Florida Healthy Kids Corporation, Tallahassee, FL 32302
What is CHIP?: "Originally created in 1997, the Children's Health Insurance Program (CHIP) is a state and federal partnership that provides low-cost health insurance coverage for children in families who earn too much income to qualify for Medicaid but cannot afford to purchase private health insurance coverage. States have considerable flexibility to establish income eligibility rules for CHIP, but children enrolling in the program must be otherwise uninsured."
source: InsureKidsNow.gov - Sponsored by the U.S. Department of Health and Human Services, Washington, DC

web page:
Medicaid Child Health Services

source:Florida Agency For Health Care Administration
languages: English
from the web page:
"Medicaid Certified School Match program... Child Health Check-Up program... Medicaid County Health Department (CHD) Certified Match Program ... Medical Foster Care...The programs above are the primary services available to Medicaid eligible children... "
- also from Florida Agency For Health Care Administration:
  web page:
  Medicaid Child Health Services - Certified School Match
  languages: English
  
  from the web page:
  "The purpose of the Medicaid certified school match program is to provide reimbursement for medically necessary services provided by or arranged by a school district for Medicaid-eligible students...."
- web page:
  Medicaid Child Health Services - Child Health Check-Up -- The Formula for Success!
  languages: English
  
  from the web page:
  "The Child Health Check-Up program is a preventive and comprehensive service for eligible children birth through 20 years of age and for children in the MediKids program..."
- web page:
  MediKids - A Florida KidCare Partner
  languages: English
  
  from the web page:
  "MediKids is a Florida KidCare Program. Administered by the Agency for Health Care Administration, the program offers low-cost health insurance coverage for children ages 1 through 4. See the MediKids Parent Information brochure for additional facts about the program...."
- web page:
  What is Florida KidCare?
  languages: English
  
  from the web page:
  "Florida KidCare is the state's children health insurance program for uninsured children. The 1998 Florida Legislature created the Florida KidCare Program, which provides health care coverage to children in families with incomes up to 200 percent of the federal poverty level. Except for Medicaid, most families pay a monthly premium of $15 or $20. KidCare consists of four programs..."
web page:
CCF - Medicaid and CHIP Programs Florida

source:Georgetown University Center for Children and Families
languages: English
from the web page:
"Florida operates two separate CHIP-funded programs. Healthy Kids covers children ages five through 19, as well as younger siblings in some locations..."
web page:
Florida Public Health Insurance for Children

source:National Center for Children in Poverty
languages: English
from the web page:
"Eligibility Criteria... Benefits... Participants... Spending..."
- also from National Center for Children in Poverty:
  web page:
  Florida Public Health Insurance for Parents
  languages: English
  from the web page:
  "Parents have access to public health insurance coverage primarily through plans that target “families”... Eligibility Criteria..."
- web page:
  Florida Demographics of Low-Income Children
  
  source:National Center for Children in Poverty
  languages: English
  from the web page:
  "Research suggests that, on average, families need an income of about twice the federal poverty level to meet their most basic needs. Children living in families with incomes below this level—$40,000 for a family of four in 2006—are referred to as low income..."
brochure or publication:
Florida Medicaid Facts

source:American Academy of Pediatrics
2 pages; languages: English

from the brochure:
"How does Medicaid help children in Florida? Children make up 54% of Florida’s Medicaid population, but are of very low cost, accounting for only 23% of the state’s Medicaid spending. In general, Florida children who are in families of four with incomes below $20,000 are eligible for Medicaid."
web page:
Premiums/Copays (Florida KidCare)

source:Florida Healthy Kids
languages: English, Spanish
from the web page:
"Most Florida Healthy Kids families pay just $15 or $20 per month. Monthly premiums depend on your household’s size and income. If you do not qualify for subsidized coverage, you may be eligible for the full-pay option..."
publication / brochure:
Children’s Health Coverage Florida

source:Children's Defense Fund
languages: English
from the web page:
"Medicaid and the Children’s Health Insurance Program (CHIP) provide affordable health coverage to 40 million children whose families would otherwise be unable to afford health insurance. A child’s eligibility for these programs is primarily based on a families’ income and assets. While there are federal guidelines for coverage, every state can set its own eligibility criteria..."
- also from Children's Defense Fund:
  brochure:
  Health Coverage for All Children: Florida
  2 pages; languages: English
  from the brochure:
  "Despite difficult economic times, Florida was one of 23 states that took steps to improve health coverage for children in the last year. In 2009, Florida took significant steps towards streamlining Medicaid/CHIP enrollment by allowing for electronic verification of income..."
web page:
Florida KidCare (SCHIP)

source:GovBenefits.gov - Your Benefits Connection
languages: English
from the web page:
"Florida KidCare offers affordable, low-cost health insurance for the uninsured children of Florida. No interview required, just fill out and mail the easy, one-page application and we will tell you if your child is eligible.

KidsCare is inexpensive; a family's payments are based on the family income and the number of children who qualify..."
web page:
Florida: CHIP Program Name and Type

source:Kaiser Family Foundation statehealthfacts.org
languages: English, Spanish
from the web page:
"Individual state profiles..."

Medicaid Benefits and Coverage: Medicaid Services

brochure:
FAMILY-RELATED MEDICAID PROGRAMS FACT SHEET (Florida)

source:Florida Department of Children and Families (DCF)
15 pages; languages: English
from the brochure:"
This family-related Medicaid fact sheet explains the various Medicaid programs for families with dependent children and pregnant women. Medicaid provides medical coverage to some low-income individuals and families. The family-related Medicaid coverage groups in Florida are based on three pieces (or titles) of the federal Social Security Act:"
brochure or publication:
Women and Medicaid in Florida

source:National Women's Law Center
3 pages; languages: English
from the brochure or publication:
"Thousands of women in Florida receive health care coverage through Medicaid.... Medicaid ensures that women in Florida have access to a comprehensive set of important health care services... Women and Medicaid in Florida: What Can Women’s Advocates Do?..."
web page:
Benefits by State: Florida (October 2008)

source:Kaiser Family Foundation
languages: English, Spanish
from the web page:
"Medicaid benefits: Online database"
brochure or publication:
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida (2003)

source:US Dep't of Health and Human Services, Substance Abuse and Mental Health Services Administration
file size: 7 pg.; languages: English
from the brochure:
"As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the Medicaid program, 1,454 enrolled in the Medicaid SCHIP expansion program and 325,992 in the separate SCHIP program. In state fiscal year 2000, Florida spent $3.27 billion to provide Medicaid services..."

Medicaid Prescription Drugs; Preferred Drug List

web page:
Florida Medicaid Preferred Drug List

source:Florida Agency For Health Care Administration
2 pages; languages: English
from the brochure: "The Florida Medicaid Preferred Drug List is subject to revision following consideration and recommendations by the Pharmacy and Therapeutics Committee and the Agency for Health Care Administration. This list is in order by the therapeutic classification. To locate a specific drug or therapeutic class, use the search feature... This list is updated from the June 23, 2010"
brochure or publication:
Florida Medicaid Prescription Drug Access Helpline

source:Florida Legal Services
languages: English
from the web page:
"Call today if Medicaid has denied your prescription drug coverage..."

Medicaid Dental Services; Dentist

brochure:
(Florida) Medicaid and MediKids Dental Benefits

source:Florida Agency For Health Care Administration
2 pages; languages: English
from the brochure: "The (Florida) Medicaid and MediKids programs cover children’s dental benefits for enrolled children provided by licensed, participating dentists. There are no copayments for covered services..."
web page:
Find an Oral Health Provider: Florida Dental Providers

source:InsureKidsNow.gov
languages: English

Other Health Coverage Options in Florida

brochure:
Florida Health Care Options Matrix™ Guide

source:Foundation for Health Coverage Education
2 pages; languages: English, Spanish
from the web page: "...hand-held guide available that outlines your state’s (Florida) public and private health care choices for individuals and groups in almost every demographic profile, as well as offers a reference list of phone numbers and Web sites..."
brochure:
Florida Health Center Fact Sheet

source:National Association of Community Health Centers (NACHC)
languages: English
from the brochure:"Florida Federally-Supported Health Centers, 2008... Number of Organizations... Number of Delivery Sites... Total Patients..."
- also from National Association of Community Health Centers (NACHC):
  web page:
  Find a Health Center
  languages: English
  from the web page:
  "If you need affordable health care, a Community Health Center may be what you're looking for... Click here to find the health center closest to your address or to see a list of health centers in your state or county/parish..."
web page:
What is Florida Healthy Kids?

source:Florida Healthy Kids
languages: English, Spanish
from the web page:
"Healthy Kids is designed to provide quality, affordable health insurance for families not eligible for Medicaid. Healthy Kids coverage includes doctor visits, immunizations, dental care, emergency care, hospital stays and much more. Most families pay just $15 or $20. Full-pay options also are available, making every Florida child ages 5 through 18 eligible...."
brochure:
Consumer Guide for Getting and Keeping Health Insurance in Florida

source:Georgetown University Health Policy Institute
file size: 45 pg.; languages: English
from the brochure:
"...Help is available to certain low-income residents of Florida who cannot afford to buy health insurance. Medicaid, Florida KidCare Program and the Florida Brogan Breast and Cervical Cancer Program offer free or subsidized health insurance coverage, direct medical services or other help..."

Florida Medicaid and Nursing Homes, Assisted Living, Long Term Care

web page:
Assistive Care Services

source:Florida Agency For Health Care Administration
languages: English
from the web page:
"This service is for low-income residents of enrolled assisted living facilities (ALFs), qualified residential treatment facilities (RTFs) and adult family-care homes (AFCHs). The purpose of the Medicaid Assistive Care Services Program is to increase state payments for recipients requiring an integrated set of services on a 24-hour per day basis. These services, provided by the residential care facilities, promote and maintain the health of eligible recipients in order to delay or prevent institutionalization... "
web page:
Medicaid - Nursing Home Benefits

source:Florida's Department of Financial Services
languages: English
from the web page:
"Medicaid does provide for custodial care or assisted care in a nursing home. However, to qualify for Medicaid long term care services, your monthly income must be less than the federal poverty level and your assets cannot exceed certain limits..."
web page:
Florida Medicaid Medicare Nursing Homes Directory

source:The Florida Long Term Care Care Project
languages: English
from the web page:
"These are Florida's Nursing Homes in cities A - Z."
- also from The Florida Long Term Care Care Project:
  brochure:
  Florida Assisted Living Guide & Directory;
  languages: English
  from the web page:
  "...A consumer's guide to information and help about assisted living in Florida, with a directory of assisted living, continuing care, and elder care sorted by Florida cities..."
- Florida Medicare Home Health Agency Directory;
  languages: English
  from the web page:
  "...A consumer's guide to information and help about Home Health care in Florida, sorted by Florida cities..."

Florida Medicare / Medicaid Dual Eligibles - Florida Medicare Savings Program

brochure:
The Qualified Medicare Beneficiary (QMB) - The Special Low-Income Medicare Beneficiary (SLMB) - The Qualifying Individuals 1 (QI-1) Programs

source:Florida Legal Services
2 pages; languages: English
from the brochure:
"If you are determined eligible for any of the Medicare Savings Plans in this brochure, you are automatically eligible for the Medicare Part D low income subsidy..."

Florida Medicaid Waiver Programs

Medicaid Community Waivers in Florida

"Home and Community-Based Services Waivers programs are the federally approved Medicaid programs authorized by Title XIX of the Social Security Act, Section 1915(c) that provide services in the home for persons who would otherwise require institutional care in a hospital, nursing facility, or intermediate care facility. "
*source: Florida Agency For Health Care Administration, Tallahassee, FL 32308

for more information, see:

brochure:
Home and Community-Based Services (HCBS) Waivers

source:Florida Agency For Health Care Administration
languages: English

More resources about Florida Medicaid Waiver Programs:

brochure:
HCBS Waiver Services

source:Florida Agency for Persons with Disabilities
2 pages; languages: English
from the brochure: "The Home and Community-Based Services waivers administered by APD offer 28 supports and services to assist individuals with developmental disabilities to live in their community..."
web page:
Contact Info and Descriptions for all Florida Medicaid 1915(c) HCBS Waivers, 2006

source:Center for Personal Assistance Services
languages: English
from the web page: "The following is a list of all Florida 1915(c) Waivers by name - complete with a description, contact information and web link..."
web page:
(Florida) Medicaid Waivers and Demonstrations List

source:Centers for Medicare & Medicaid Services
languages: English
from the web page:
"...This list contains information about state-specific Medicaid waiver and demonstration programs. Users can access fact sheets, copies of proposals, approval letters, and other documents related to specific programs..."

Report Medicaid Fraud in Florida

web page:
Medicaid Fraud Control Unit

source:Florida Attorney General
languages: English
from the web page: "To report fraud or abuse, individuals may use the statewide hotline number or contact the Medicaid Fraud Control Unit nearest them..."
hotline:
Toll-free Hotline to Report Medicaid Fraud:
According to the Florida Attorney General’s Office : "1-866-966-7226"

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Florida Medicaid

topics: Florida Medicaid: Florida Public Health Insurance: medical coverage, centers for Medicaid; Medicaid In Florida; Medicaid Assistance information; TX; definition Medicaid Florida: Florida Medicaid Eligibility: Applying for Florida Medicaid: Medicaid: Health Programs for Children: CHIP: