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Recipient Support

Managed Care Recipients

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.

Fee-For-Service Recipients

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.

Additional Reference Information

Medicaid Behavior Analysis Service Providers [99KB]

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:

  • Department of Children and Families, Office of Economic Self Sufficiency - The Department of Children and Families determines eligibility for low-income children and family programs and the institutional care program.
    • Apply for Medicaid, Food stamps, TANF
    • Gold Card Replacement
    • Check on Eligibility Status
    • Medical Bill Tracking for Medically Needy
    • Report Changes to your household
    • DCF approved Community Partners [123KB PDF] (local organizations to help with applications
  • Social Security Administration - The Social Security Administration determines eligibility for the Supplemental Security Income (SSI) program. The SSI-Related Programs Fact Sheet contains information about Medicaid eligibility criteria for the aged, blind and disabled, including Medicare cost-sharing coverage for Qualified Medicare Beneficiaries (QMBs), Specified Low-Income Beneficiaries (SLMBs), and coverage for Qualified Individuals.

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.