Florida law mandates that the majority of Medicaid recipients enroll in managed care. If you are enrolled in a Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) or Managed Medical Assistance (MMA) plan go to the SMMC website for more information. Managed care recipients should contact their plan for information on network providers and covered services.
Recipients who are not required to enroll in managed care obtain services through the Medicaid enrolled providers of their choice on a fee-for-service basis. For assistance with Medicaid Fee For Service contact the Medicaid Help Line at 1-877-254-1055.
Children’s Medical Services Plan Eligibility
Effective Monday, January 11, 2016, a new Florida Department of Health rule was enacted to govern how children can be determined clinically eligible for the Children’s Medical Services Medicaid Managed Medical Assistance plan (CMS plan). Under Rule 64C-2.002 of the Florida Administrative Code, treating physicians may attest to a current diagnosis and functional limitation qualifying children with chronic and serious conditions as a referral for enrollment into the CMS plan.
If you are the treating physician of a child and you would like to attest to the eligibility of your patient for the CMS plan, please review the CMS Clinical Eligibility Attestation for Physicians and a list of qualifying chronic and serious conditions. Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at CMS.ClinicalEligibilityScreening@flhealth.gov or via fax to 850-488-3813. Please be sure to submit all five pages of the attestation.
If physicians have questions about the CMS Clinical Eligibility Attestation, please contact a CMS plan nurse at 850-245-4444, extension 3291.
Recipient eligibility for Medicaid is determined by the:
AHCA is also the lead agency for the Children’s Medical Insurance Programs (Title XXI–SCHIP). In Florida, this program is known as the Florida KidCare program and is the state's children health insurance program for uninsured children.
Each program has its own income and asset requirements.