Florida Medicaid: An Intro

In our Medicaid vs. Medicare post we covered the basic differences between the two programs. Each state manages their Medicaid program under guidance from the Centers for Medicare & Medicaid Services, therefore each state outlines its eligibility rules and covered services. The basic premise is that eligible older people, people with disabilities (as determined by SSA DDS), and some families with children (in some states) within the income and resource requirements receive coverage through Medicaid. The names of the Medicaid program may vary from state to state. We’re going to cover Florida Medicaid in this post, but be sure to visit our Medicaid Resources page for more information on other state Medicaid benefits.

In 2014 Florida Medicaid transitioned to the Statewide Medicaid Managed Care (SMMC) program. This is where most Medicaid recipients receive their Medicaid services. All you really need to know is that under this umbrella there are two different parts:

• The Managed Medical Assistance (MMA) Program
• The Long-term Care (LTC) Program

When an individual qualifies for benefits, they are enrolled in MMA and receive all their health care services (except for long-term care) from a “managed care” plan. Medicaid recipients who qualify and become enrolled in LTC will receive long-term care services from a “Long-term Care managed care” plan. BASICALLY, these are just bureaucratic terms used for the paperwork in their offices. You just need to know that if you:

• Are a “disabled” (per Social Security Administration) adult or otherwise eligible, pregnant, or a child you get benefits under MMA.
• Are an older adult in a rehabilitation stay following a 3 night hospitalization or in a nursing home receiving LTC, then you fall in the LTC benefits program.

It’s useful to know these terms in the event you have to call Medicaid or the Department of Children and Families (DCF) and need to be directed to the correct department or for dealing with representatives in the various agencies involved in the SMMC program. DCF is the agency the manages the application, review, and approval/denial process of Medicaid in Florida. When you apply for Medicaid it is important that you follow the instructions and requests from DCF or your case will be held up if not denied.

It is recommended that you select your MMA plan at the time of application. To select your MMA plan at the time you apply, you can call 1-877-711-3662 or enroll via the express enrollment website by clicking here.  If not, upon approval you will receive a list of MMA plans providers and what is covered. Be sure to review the various plans offered (like any other insurance program) to make sure you select the MMA plan that is best for you. This means finding the plan that covers the prescriptions and/or treatments you need. You’ll also need to discuss with your medical providers what insurance companies they prefer working with as this can also be a factor. If you do not select a plan, a plan will be selected automatically for you which may not cover something you need and this will lead to you having to pay out of pocket (if it isn’t just too expensive it can’t be afforded). Also, keep in mind that the SMMC program will not change your Medicare benefits.

Here are some links that provide more information on the Statewide Medicaid Managed Care program:

Agency for Healthcare Administration 

Medicaid Landing Page

Online Florida Medicaid Application

The policies and procedures of Florida Medicaid can be overwhelming without experience in dealing with the system, but with time and research, anyone can handle it. However, if you are juggling work, family responsibilities, physical impairments, and residual stress/emotions, AyudaCon.com is available to manage the Medicaid application, review, approval/denial, and care management process. Contact us for more information on our services and fees.