Florida Medicaid

1
Florida Medicaid

• Beth Kidder
• Bureau Chief, Medicaid Services
• Florida Agency for Health Care Administration
• Governors Task Force on
• Autism Spectrum Disorders
• April 3, 2008

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What is Medicaid?

• Medicaid is a health insurance program for
  certain groups of low income individuals.
• Medicaid is jointly financed by state and federal
  funds.
• Designated state Medicaid agency works within
  federal guidelines to
• Establish eligibility standards.
• Determine benefits and services.
• Set payment rates.

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Florida Medicaid A Snapshot
4
Medicaid Facts

• Medicaid serves the most vulnerable in Florida
• 27 of children.
• 51 of deliveries.
• For every 1 spent on Medicaid care in Florida
• Federal government pays 0.57
• State pays 0.43

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Medicaid Budget - How it is Spent
Adults
Children
Blind Disabled
Elderly 65
Adults and children refers to non disabled
adults and children.
6
Eligibility

• In Florida, the Department of Children and
  Families or the Social Security Administration
  determine Medicaid eligibility.
• 2 major components financial and categorical

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Eligibility Financial

• Must meet certain income and resource
  requirements
• Income Anything which can be used to meet basic
  needs for food, clothing, and shelter (day-to-day
  needs).
• Resources Assets which an individual owns and
  can convert to cash to meet basic needs (e.g.,
  real estate other than home, savings accounts).

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Eligibility Categorical

• An individual must fit in a category
• Supplemental Security Income recipients.
• Pregnant women and their children.
• Families with children.
• Children ages 19 and 20.
• Women under breast cancer and cervical treatment
  program.
• Elderly, blind, disabled.

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Examples of Mandatory Services

• Hospital (inpatient outpatient)
• Physician
• Nursing Facility
• Home Health
• Rural Health Clinic
• Child Health Check-Up

• Family Planning
• Nurse Practitioner
• Transportation
• Laboratory and X-ray
• Medical and Surgical Dental Services

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Examples of Optional Services

• Prescribed drugs
• Durable Medical Equipment
• ICF/DD
• Clinic services
• Eyeglasses and optometrist services
• Prosthetic devices
• Private duty nursing
• Hospice

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Home and Community Based Services Waivers

• Waive placement in institutions
• Nursing Homes
• Intermediate Care Facilities for the
  Developmentally Disabled
• Services are received in
• The community
• At home

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Floridas HCBS Waivers

• Adult Cystic Fibrosis
• Adult Day Health Care
• Aged/Disabled Adult
• Alzheimers Disease
• Assisted Living for the Elderly
• Channeling Waiver
• Familial Dysautonomia
• Model
• Nursing Home Diversion
• Project AIDS Care
• Traumatic Brain Injury/Spinal Cord Injury

• Waivers for People with Developmental
  Disabilities
• Developmental Disabilities (Tier 1)
• Tier 2
• Tier 3
• Family and Supported Living (Tier 4)

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Eligibility Categories for DD Waivers

• Diagnosis of
• Autism
• Cerebral Palsy
• Spina Bifida
• Prader Willi Syndrome
• IQ of 59 or less
• AND substantial limitations in 3 life activities
• Self-care, learning
• Mobility, self-direction
• Understanding and use of language
• Capacity for independent living

• IQ of 60-69 with one major handicapping condition
  or substantial limitations in 3 life activities

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Waiver Operation

• Medicaid delegates day-to-day operating authority
  for the developmental disability waivers to the
  Agency for Persons with Disabilities
• APD duties
• Determine eligibility for the waiver
• Approve individual service plans
• Recruit providers
• Manage the budget
• Medicaid duties
• Ensure the waivers comply with federal law
• Promulgate administrative rules for the waivers
• Enroll waiver providers
• Pay waiver service claims
• Oversee quality assurance

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For questions about Medicaid services, please
contactBeth KidderBureau Chief for Medicaid
Serviceskidderb_at_ahca.myflorida.com850-488-9347