Medicaid State Plan Under Title XIX of the Social Security Act Medical Assistance Program

Florida's Medicaid State Plan (the Plan) is a large, comprehensive written statement describing the scope and nature of the Medicaid program. The Plan outlines current Medicaid eligibility standards, policies and reimbursement methodologies to ensure the state program receives matching federal funds under Title XIX of the Social Security Act.

Under the Florida Sunshine Law, the Plan is a public record. This Web site provides a secure link to a complete copy of the Plan, Part I and Part II, as well as a divided version further below. The divided version is sorted in the most logical format, while still following the correct order of the document. Both copies are searchable by word or phrase using the “Search” function in Adobe Acrobat Reader. If additional help is needed, please contact April Cook in the Bureau of Medicaid Services at (850) 412-4003.


ACA Related State Plan Amendments

Affordable Care Act/Medicaid Eligibility documents (also known as Modified Adjusted Gross Income or MAGI) State Plan amendments for Medicaid and CHIP, have been submitted to the Centers for Medicare and Medicaid Services (CMS). To find the ACA related documents (and their approval status), please go to the following link:  ACA web page.


**Due to the large file size, these documents may take longer to download.**

Florida Medicaid State Plan Part I [15.58MB PDF] Updated April 16, 2014
 

Florida Medicaid State Plan Part II [20.39MB PDF] Updated April 16, 2014

Table of Contents [151KB PDF]

Section 1 Single State Agency Organization [390KB PDF]

1.1 Designation and Authority
1.2 Organization for Administration
1.3 Statewide Operation
1.4 State Medical Care Advisory Committee and Tribal Consultation Requirements
1.5 Pediatric Immunization Program

Section 2 Coverage and Eligibility [172KB PDF]

2.1 Application Determination of Eligibility and Furnishing Medicaid
2.2 Coverage and Conditions of Eligibility
2.3 Residence
2.4 Blindness
2.5 Disability
2.6 Financial Eligibility
2.7 Medicaid Furnished Out of State

Section 3 Services: General Provisions [670KB PDF]

3.1 Amount, Duration and Scope of Services
3.2 Coordination of Medicaid with Medicare Part B
3.3 Medicaid for Individual Age 65 or Over in Institutions for Mental Disease
3.4 Special Requirement Applicable to Sterilization Procedure
3.5 Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries Families Receiving Extended Medicaid Benefits

Section 4 General Program Administration [2.47MB PDF] Updated 4/16/2014

4.1 Methods of Administration
4.2 Hearings for Applicants and Recipients
4.3 Safeguarding Information on Applicants and Recipients
4.4 Medicaid Quality Control
4.5 Medicaid Agency Fraud Detection and Investigation Program
4.6 Reports
4.7 Maintenance of Records
4.8 Availability of Agency Program Manuals
4.9 Reporting Provider Payments to the Internal Revenue Service
4.10 Free Choice of Providers
4.11 Relations with Standard-Setting and Survey Agencies
4.12 Consultation to Medical Facilities
4.13 Required Provider Agreement
4.14 Utilization/Quality Control
4.15 Inspection of Care in Intermediate Care Facilities for the Mentally Retarded, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Hospitals
4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
4.17 Liens and Adjustments or Recoveries
4.18 Recipient Cost Sharing and Similar Charges
4.19 Payment for Services
4.20 Direct Payments to Certain Recipients for Physicians' or Dentists' Services
4.21 Prohibition Against Reassignment of Provider Claims
4.22 Third Party Liability
 
Memorandum of Understanding
4.23 Use of Contracts
4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
4.25 Program for Licensing Administrators of Nursing Homes
4.26 Drug Utilization Review Program
4.27 Disclosure of Survey Information and Provider or Contractor Evaluation
4.28 Appeals Process
4.29 Conflict of Interest Provisions
4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals
4.31 Disclosure of Information by Provider and Fiscal Agents
4.32 Income and Eligibility Verification System
4.33 Medicaid Eligibility Cards for Homeless Individuals
4.34 Systematic Alien Verification for Entitlements (SAVE )
4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation
4.35 Enforcement of Compliance for Nursing Facilities
4.36 Required Coordination Between the Medicaid and WIC Programs
4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities
4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
4.40 Survey & Certification Process
4.41 Resident Assessment for Nursing Facilities
4.42 Employee Education About False Claims Recoveries
4.43 Cooperation with Medicaid Integrity Program Efforts
4.44 Prohibition on Payments to Institutions Outside the US

Section 5 Personnel Administration [83KB PDF]

5.1 Standard of Personnel Administration
5.2 RESERVED
5.3 Training Programs; Subprofessional and Volunteer Programs

Section 6 Financial Administration [69KB PDF]

6.1 Fiscal Policies and Accountability
6.2 Cost Allocation
6.3 State Financial Participation

Section 7 General Provisions [107KB PDF]

7.1 Plan Amendments
7.2 Nondiscrimination
7.3 Maintenance of AFDC Effort
7.4 State Governor's Review

Attachments

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