Florida Medicaid: How Does It Work?

Florida Medicaid is a medical assistance program that provides Florida residents access to health care, typically for low-income families and individuals. In addition, Medicaid also helps Florida’s elderly and people with disabilities with the expense of nursing facility care, as well as other medical and long-term care expenses.

Florida’s Medicaid State Plan is a large, comprehensive written statement describing the scope and nature of the Medicaid program. It details the state’s current Medicaid eligibility standards, policies, and reimbursement system to ensure the state program receives matching federal funds under Title XIX of the Social Security Act. The state covers long term care needs up to 300% SSI.

The Agency for Health Care Administration, the Florida Department of Children and Family, and the Florida Department of Elder Affairs are the government agencies responsible for Medicaid here in Florida.

Florida Medicaid & Statewide Medicaid Managed Care (SMMC) Program
The Agency for Health Care Administration finished its implementation of the Statewide Medicaid Managed Care (SMMC) program in 2014. With the completion of this program, most Medicaid recipients are enrolled in a health plan…the nationally accredited health plans were chosen through a competitive procurement for participation in the program.

The Agency for Health Care Administration is responsible for administering the SMMC program and re-procuring health plans every five years. This program has two parts: the Long-Term Care (LTC) program and the Managed Medical Assistance (MMA) program.

Invitation to Negotiate (ITN)
Florida Medicaid is developing the Invitation to Negotiate (ITN), which is aimed at re-procuring health plans for the SMMC program.

Florida currently has 11 standard capitated plans, five specialty capitated plans, and a specialty plan providing services on a non-risk managed fee-for-service (FFS) basis.

Who’s Enrolled?
Florida residents age 65 and over make up 19% of the state’s population. That’s more than 3.7 million people. In 2014, there were 610,500 seniors participating in Florida Medicare, which was 13% of all the enrollees in the state.

In 2015, Certified Nursing Facility Residents with Medicaid made up over half of those senior participants (57%). The amount spent on these individuals was nearly $55M.

Contact Us
If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.