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Disease Management

Disease management is designed to improve the health and well being of Medicaid patients, provide additional resources to primary care and specialty providers, and reduce costs associated with patients who have a chronic disease.

The Agency for Health Care Administration has contracted with disease management programs to provide disease management services to adults and children enrolled in certain Medicaid healthcare programs who have asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes, end stage renal disease, hemophilia, HIV/AIDS, hypertension (high blood pressure), sickle cell anemia, chronic fatigue syndrome, fibromyalgia and chronic back or neck pain.

Disease Management Programs

Enrollment in Disease Management

Medicaid identifies eligible recipients for disease management.  Participants have the option to disenroll at any time.  Adults and children with hemophilia may not disenroll, but may choose between the two contracted hemophilia disease management providers.  Eligible recipients are notified by Medicaid for participation in the program. 

Who is Eligible?

Medicaid beneficiaries eligible for the Healthier Florida Disease Management Program services include:

• All MediPass beneficiaries who meet the criteria for one or more of the following disease states:  Asthma, Diabetes, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Hypertension, Renal Disease, and Sickle Cell.
• Beneficiaries who are not enrolled in another disease management program.

Each month, approximately 56,000 beneficiaries are eligible for Healthier Florida and approximately 8,000 beneficiaries are care managed.

Medicaid beneficiaries eligible for the Comprehensive Hemophilia Disease Management Program services include:

• All Medicaid eligible beneficiaries diagnosed with hemophilia who have been prescribed factor replacement products.
• MediPass beneficiaries, beneficiaries enrolled in a Minority Physician Network or Provider Service Network, or fee-for-service Medicaid beneficiaries.
• Beneficiaries enrolled in both Medicare and Medicaid may voluntarily participate.

Hemophilia disease management enrollees may also be enrolled other disease management programs if they meet eligibility criteria.

Approximately 200 beneficiaries receive services each month from the Hemophilia Disease Management Programs.

Medicaid beneficiaries eligible for HIV/AIDS Disease Management Program services include:

• Medipass beneficiaries and fee for service Medicaid eligible beneficiaries diagnosed with HIV or AIDS
• Beneficiaries participating in MediPass
• PAC Waiver Services (Project AIDS Care) recipients who have either MediPass, fee-for-service Medicaid, or Medicare, not enrolled in a Managed Care Organization (CMS, HMO, PSN, MPN) and not covered by a primary health insurance other than Medicaid.
• Beneficiaries who are not enrolled in another disease management program with the exception of Hemophilia Disease Management.

An average of 6,500 beneficiaries are managed each month by the HIV/AIDS Disease Management Program.

Medicaid beneficiaries eligible for Integrative Medical Therapies Program services include:

• MediPass beneficiaries who meet the criteria for one or more of the following disease states or conditions:  Chronic Fatigue Syndrome, Fibromyalgia and Chronic Back or Neck Pain
• All MediPass beneficiaries with the above conditions living in the following counties: Pasco, Pinellas, and Hillsborough
• Beneficiaries who are not enrolled in another disease management program.

Each month, approximately 300 – 500 beneficiaries are managed and receive integrative medicine services.

Provider Involvement

The Agreement for Participation in MediPass requires the physician to work closely with the disease management Program.  Providers may refer their MediPass patients who are not already enrolled and who may benefit from a disease management program.  The disease management care managers become an extension of the physician’s services by helping the enrolled patients better understand their diseases and make necessary lifestyle changes with the goal of self-management.  Disease management programs serve as a resource to providers for current clinical practice guidelines.

Document Archive

To view past disease management presentations and reports, please click here.

To view past program ITN’s, please click here.