Medicaid is Different from Medicare
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.
Medicare is a federal
health insurance program for people who are age 65 or older or
disabled. It is administered by the federal Department of Health and
Human Services,
Centers for Medicare and Medicaid Services (CMS). Eligibility for
Medicare is not based on the person's income or assets.
For more information, please click on the following links:
Medicare Advantage Special Needs Plan
Florida Medicaid will coordinate with Medicaid-Enrolled Medicare Advantage Special Needs Plans to cover cost sharing (deductibles and co-insurance) for beneficiaries who are eligible for both Medicare and Medicaid (duals), and who are enrolled in a Medicare Advantage Special Needs Plan (MA SNP).
The Agency will establish for each calendar year, through negotiation with the participating MA SNP providers and actuarial consultation, the monthly per member payment for MA SNP members. Medicare Advantage Special Needs Plan providers will be notified each year of the amount payable for the forthcoming calendar year. For CY 2008, for MA SNP members residing in Palm Beach County, Broward County, Miami-Dade County or Monroe County, the monthly per member payment will be $15.00. For CY 2008, for MA SNP members residing in the remaining AHCA Areas, the monthly per member payment will be $50.00.
A Medicare Advantage Special Needs Plan not enrolled in Medicaid as an active Medicaid provider must complete the full Medicaid Enrollment Provider Application found on the fiscal agent website (under "Provider Support", then "Enrollment"), and the Non-Institutional Provider Agreement Addendum for Medicare Advantage Special Needs Plan (MA SNP) Crossover Providers.
If a Medicare Advantage Special Needs Plan is already enrolled in Medicaid as an active health care plan, the documents listed below and the above mentioned Non-Institutional Provider Agreement Addendum for Medicare Advantage Special Needs Plan (MA SNP) Crossover Providers are required to be submitted for activation with the Medicaid fiscal agent as a MA SNP provider type. All documents submitted must be completed legibly and have original signatures. These forms may be found on the Medicaid fiscal agent website.
- Fingerprint cards and required screening fee ($42.25 per screening) for all:
- Shareholders (five percent or more ownership);
- Partners of your business and subcontractors;
- Individual officers;
- Directors;
- Managers;
- Financial records custodian; and
- Individuals who hold signing privileges on the depository account.
- Non-Institutional Medicaid Provider Agreement (MPA)
- Signed by all above listed persons; or
- The CEO or President may sign in lieu of the above.
- Authorization Agreement for Electronic Funds Transfer (EFT)
- Attach letter from financial institution verifying the name on the account, as well as, the account and routing numbers; and
- Anyone who signs the EFT form must meet background screening requirements.
- Electronic Claims Submission (ECS) Agreement
- Electronic Remittance Voucher (ERV) Agreement
- EDI Information Sheet
Any of the above who have submitted fingerprint cards to Medicaid within the past ten years do not need to resubmit. However, any who need to be resubmitted or added to the file must submit fingerprint cards and appropriate fees.
Please provide notification that the above information was submitted to the Medicaid fiscal agent and copy of the MA SNP approval letter and attachments from the Centers for Medicare and Medicaid Services under a cover letter to:
Christina Lopez, Government Analyst II
Agency for Health Care Administration
2727 Mahan Drive, MS #50
Tallahassee, FL 32308
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