Welcome to the Agency for Health Care Administration’s (the Agency’s) 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, we 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.

Florida Medicaid Reform (2011-2014)
Approved 3-Year Extension of the 1115 Research and Demonstration Waiver

On December 15, 2011, the Centers for Medicare and Medicaid Services (CMS) approved the 3-year waiver extension request the Agency

submitted on June 30, 2010. The waiver extension period for Florida’s Section 1115 Research and Demonstration Waiver is December 16, 2011 through June 30, 2014. The following are links to the federal approval documents for the 3-Year waiver extension request.

• CMS Approval Letter, 12/15/11
• CMS’s Waiver Authorities and Special Terms and Conditions, 12/15/11

Click here for the Waiver Extension Request and related Documents, 06/30/10-12/15/11.
Click here for clarification from CMS regarding Low Income Pool Tier-One Milestone, 12/13/11.

1115 Amendment Requests

Please click on the following link to view the amendment requests submitted to CMS in accordance with CS/HB 7107 on
August 1, 2011.

http://ahca.myflorida.com/Medicaid/statewide_mc/index.shtml

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 each year of the waiver.  The annual reports are completed and made available 120 days after the end of each demonstration year

Click here to view the completed annual reports. 

Medicaid Reform Quarterly Reports

The quarterly progress reports provide an analysis and the status of the various operational areas of the 1115 research and demonstration waiver.  The quarterly reports are completed and made available 60 days after the end of each quarter.

Click here to view the completed quarterly reports. 

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://apps.ahca.myflorida.com/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.

Enhanced Benefits Reward$ 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:

• Beneficiaries
  • Enhanced Benefits Products
  • Universal Form (English and Spanish)
  • Enhanced Benefits Reward$ Program Welcome Letter (English and Spanish)
  • Frequently Asked Questions
• Providers
• Monthly Enhanced Benefits Report
• Enhanced Benefits Panel Meetings
• EBIS Health Plan Credit File Validator

Presione (Click) aquí para obtener esta información en español

Choice Counseling and Other Beneficiary Information

• Medicaid Reform Choice Counseling
• Medicaid Reform Training for Beneficiaries
• Choice Counseling Face-to-Face Sessions
• Medicaid Reform Brochure for Medicaid Beneficiaries

Provider Information

As part of the Agency’s commitment to enhancing the implementation of reform, the Agency continues to expand its communication with providers that are considering developing a benefit package and submitting an application as a Medicaid HMO or Provider Service Network. This web page is one of many ways that the Agency communicates with potential plan applicants and current health plan contractors to provide the tools needed to complete the application and contracting processes. We encourage you to visit this site regularly.

Current Year:

Year Four - Broward, Duval, Baker, Clay, and Nassau Counties

Previous Years:

Year Three - Broward, Duval, Baker, Clay, and Nassau Counties

Year Two - Broward, Duval, Baker, Clay, and Nassau Counties

Year One - Broward and Duval Counties

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, along with the Bureau of Health Systems Development, 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.

Policy Transmittals - Reform

HMO Provider-Related Information - Non Reform

Technical Advisory Panel (TAP)

The Agency for Health Care Administration (AHCA) appointed nine people to serve on the Medicaid reform Technical Advisory Panel. The Panel was created by the Florida Legislature in House Bill 3B and will advise AHCA on various implementation issues with Medicaid reform. Click here to proceed to the TAP information.

Florida Medicaid Reform (2005-2011)
Approved 1115 Research and Demonstration Waiver Initial 5-Year Application

CMS approved the Agency’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. The Agency’s 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.

In December 2005, the Agency submitted an implementation plan to the Florida Legislature which summarized the implementation milestones and activities that had been undertaken and would be completed before beginning operation of the waiver on July 1, 2006, and, if legislative approval had been obtained, expansion statewide by 2011. Click here to proceed to the implementation plan.

Please mail your comments or suggestions to:

Medicaid Reform
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308

Email your comments and suggestions on Medicaid reform to
medicaidreform@ahca.myflorida.com