Welcome to the Agency for Health Care Administration’s (AHCA) Medicaid reform website.
Florida is leading the nation in changing the Medicaid program. For the first time, we will offer true flexibility in the program so health plans can better target the needs of the program’s participants. We believe this innovative approach will better match health care services with the needs of the citizens we serve. Together, can create a better Medicaid program.
We encourage you to visit the reform website frequently for information on upcoming meetings, updates on the status of reform implementation and other relevant information.
Medicaid Reform Expansion
During the 2005 Special Session, the Legislature authorized the expansion of Medicaid Reform to Baker, Clay, and Nassau Counties. Medicaid Reform expansion was implemented July 1, 2007, in these counties.
The Agency for Health Care Administration (Agency) is authorized to contract with Provider Service Networks, Health Maintenance Organizations, and other licensed insurers in the above mentioned counties in areas where Medicaid Reform has been implemented. The plans will provide services to the Children and Families populations (TANF) and Aged and Disabled individuals (SSI population). The State may also contract with specialty plans to serve the needs of Children's Medical Services enrollees and beneficiaries diagnosed with HIV/AIDS.
Potential plans are provided the opportunity to participate in Reform through the release of a Reform Health Plan application by the Agency. The Reform Health Plan application was released on December 1, 2006, and Reform plans applicants may submit the completed application to the Agency at any time for review. Health plans not currently participating in the reform must complete and submit the Reform Health Plan Application to be eligible to participate in any of the five Reform counties.
Additionally, the Agency has posted the Reform Health Plan Expansion Application for existing (contracted) HMOs, PSNs and other licensed insurers who intend to expand service provision to Clay, Baker and Nassau Counties. Expansion Applications received by April 1, 2007, were reviewed for July 2007 contract amendment execution and subsequent enrollment effective September 2007. Current Reform plans who are interested in participating in the expansion areas may submit the Reform Health Plan Expansion Application to the Agency at any time for review.
All plans will be required to develop provider networks that will provide comprehensive health care services to Medicaid beneficiaries. Providers may be contacted by potential Reform plans who will be soliciting providers to participate in their networks. The Agency encourages providers to explore opportunities within the plan networks.
Medicaid Reform Training for Beneficiaries
Beginning in July 2007, there will be changes to Florida Medicaid in Baker, Clay, and Nassau Counties. These changes are needed to better meet the health care needs of Florida Medicaid beneficiaries. These changes are called “Medicaid Reform”. In Baker, Clay, and Nassau, beginning in April 2007, the local Medicaid office will be offering training meetings on these changes. If you would like to attend one of these meetings, please click on the link below and you will be guided to a site where you can sign up.
http://ahcaxnet.fdhc.state.fl.us/medres/index.aspx
Anyone needing further information, or special accommodations under the Americans with Disabilities Act of 1990 (for example, Braille or large print documents, sign language interpreter services, or closed-captioning) should contact the Medicaid Area Office at 1 (904) 353-2100 or toll free at 1 (800) 273-5880. Special accommodation requests under the Americans with Disabilities Act should be made at least seven business days prior to the public meetings. If TTY service is needed, Medicaid beneficiaries can call 1 (800) 955-8771 for assistance.
Medicaid Reform Quarterly Reports
The Agency is required to submit a quarterly progress report to the Centers for Medicare and Medicaid Services (CMS) no later than 60 days following the end of the each quarter as specified in Special Terms and Conditions #22 of the approved 1115 Medicaid Reform Waiver.
The quarterly reports submitted to CMS, in compliance with Special Terms and Conditions #22, are provided below. Each report provides a detailed summary of the events that occurred during the quarter being reported.
To view the quarterly reports for year 1 of the demonstration, please click on the links below.
1st Medicaid Reform Quarterly Report, July 1, 2006 through September 30, 2006 [431KB PDF]
2nd Medicaid Reform Quarterly Report, October 1, 2006 through December 31, 2006 [383KB PDF]
3rd Medicaid Reform Quarterly Report, January 1, 2007 through March 31, 2007 [1.09MB PDF]
4th Medicaid Reform Quarterly Report, April 1, 2007 through June 30, 2007 [1.72MB PDF] |
Medicaid Reform Annual Report
The annual report documents accomplishments, project status, quantitative and case-study findings, utilization data, and policy and administrative issues in the operation of the 1115 research and demonstration waiver for the time period July 1, 2006, through June 30, 2007.
As specified in s. 409.91213(1)(b), Florida Statutes, the Agency submitted the draft annual report on October 1, 2007, to the Governor, the President of the Senate, the Speaker of the House of Representatives, the Minority Leader of the Senate, the Minority Leader of the House of Representatives, and the Office of Program Policy Analysis and Government Accountability (OPPAGA). The draft annual report was then submitted to the Centers for Medicare and Medicaid Services (CMS) as required by Special Terms and Condition (STC) #23 of the waiver on October 3, 2007.
As required by STC #23, the Agency submitted the final report to CMS on November 3, 2007, which incorporated recommendations provided by CMS on October 11, 2007. CMS recommended the draft report be revised on page 103 to clarify that expansion of the waiver will only occur as authorized by the Florida Legislature. The final report was submitted to the Governor, Senate President, House Speaker, Minority Leaders in the House and Senate, and OPPAGA on November 9, 2007.
To view the draft annual report, please click on the link below.
Florida Medicaid Reform Year 1, Draft Annual Report, July 1, 2006 – June 30, 2007 [801KB PDF]
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To view the final annual report, please click on the link below.
Florida Medicaid Reform Year 1, Final Annual Report, July 1, 2006 – June 30, 2007 [805KB PDF] |
Enhanced Benefits Account Program
Florida Medicaid wants to encourage you to make healthy choices and participate in activities that will help keep you from getting sick. Beneficiaries in Florida Medicaid Reform plans will be eligible for enhanced benefits if they take part in specific activities. The goal is to reward your healthy behavior.
Click on the links for more information on Enhanced Benefits for:
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Beneficiaries
- Enhanced Benefit Products
- Universal Form (English and Spanish)
- Program Brochure (English and Spanish)
- Frequently Asked Question
- Providers
- Monthly Enhanced Benefits Report
- Enhanced Benefit Panel Meetings
3/26/08
- EBIS Credit File Validator
Choice Counseling and Other Beneficiary Information
- Medicaid Reform Choice Counseling
- Medicaid Reform Training for Beneficiaries
- Choice Counseling Face-to-Face Sessions for April
3/27/08
- Services for Disabled
- Benefit Comparison Charts
- Medicaid Reform Brochure for Medicaid Beneficiaries
Provider Information
Year Two
- Call for Letters of Intent to Offer a Medicaid Reform Plan in Baker, Clay and Nassau Counties
- Letter of Intent Submitted by Health Plans, December 1, 2006
- Medicaid Reform Training for Beneficiaries
- Provider Training in Baker, Clay and Nassau Counties
- Florida Medicaid Reform Health Plan Application, December 2006
- Florida Medicaid Reform Health Plan Expansion Application
- Disclosure of Ownership and Control Interest Statement (CMS-1513)
- Florida Medicaid Reform Data Book
- Florida Medicaid Reform Plan Evaluation Tool
- Final Reform Capitation Rates
- Provider Relations Contact Information for Reform Health Plans
Year One
- Medicaid Reform Performance Measures Workshops
- Medicaid Reform Applicants
- Provider Relations Contact Information for Reform Applicants
- Reform Rates
- Benefit Comparison Charts
- Choice Counseling Transition of Reform Population
- Florida Medicaid Reform Data Book Request
- Florida Medicaid Reform: Medicaid RX Model
- Florida Medicaid Reform Plan Evaluation Tool
- Medicaid Reform Health Plan Application Frequently Asked Questions
Low Income Pool (LIP)
The Low Income Pool (LIP) is established to ensure continued government support for the provision of health care services to Medicaid, underinsured and uninsured populations. Click here to proceed to the LIP information.
Medicaid HMOs
The State of Florida purchases health care services from commercially licensed HMOs. The Bureau of Managed Health Care is responsible for the approval and monitoring of all Medicaid HMO contracts in the state. Bureau staff conduct desk and on-site reviews throughout the year to ensure contract compliance.
Click here to proceed to reports on HMO Comprehensive Enrollment Reports.
Florida Medicaid Reform Implementation Plan
This document summarizes the implementation milestones and activities the Agency has undertaken and will complete to begin operation of the waiver on July 1, 2006, and, with legislative approval, expand statewide by 2011. In developing the implementation plan, the Agency has conducted outreach and education to obtain comments and share information through workshops with providers, advocacy groups, recipients, and all interested parties. Click here to proceed to the implementation plan.
Florida Medicaid Reform
Approved 1115 Research and Demonstration Waiver Application
CMS approved AHCA’s proposal to waive certain federal statutory provisions and move forward in reforming Medicaid as authorized by Senate Bill 838. The draft 1115 waiver application was posted on Agency's website on August 31, 2005. AHCA submitted the waiver application on October 3, 2005, after posting the draft application for 30 days as required by Senate Bill 838. CMS reviewed the application and after intensive negotiations with Florida, granted approval. The Florida legislature granted approval to implement Medicaid reform on December 8, 2005. To view the approved waiver, click on the following link. Click here to proceed to the waiver.
