Issues To Consider As Children Transition To Other Sources Of Coverage
If the household income of a child enrolled in Medicaid has increased, the child will likely be eligible for CHIP while a minority may be eligible for subsidized federal and state marketplace coverage. Some children may have a parent who has an offer of employer coverage, although affordability may be a barrier. While all children could face difficulties in transitioning to other coverage, transition issues will likely be more challenging in the 34 states with separate CHIP programs compared to the 16 states and D.C., where all CHIP-funded children are enrolled in Medicaid.
Finding Out You’re Pregnant Can Be Exciting And Overwhelming
Your baby is growing and your body is changing, and the more you know about whats happening in your body, the more in control youll feel. Thats why one of the most important things you can do is choose a prenatal care provider who can help you while youre pregnant. A provider who sees you regularly, can spot health problems early and can talk to you about how you can help your unborn baby.
Mothers in prenatal care have healthier pregnanciesmothers who are not in care are three times more likely to have a baby of low birth weight and five times more likely to have a baby who dies at birth.
Apply For Medicaid In Florida
Online at ACCESS Florida, or submit a paper application by mail, fax or in person to a local service center. For help with the application process, call 866-762-2237.
Eligibility: Children up to 1 year old with family income up to 206% of FPL children 1-5 with family income up to 140% of FPL children 6-18 with family income up to 133% of FPL pregnant women with family income up to 191% of FPL young adults 19-20 with family income up to 30% of FPL adults with dependents with family income up to 30% of FPL.People who qualify for Supplemental Security Income automatically qualify for Medicaid. For information: SSI-Related Programs Financial Eligibility Standards
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Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
How Do I Enroll In Medicaid In Florida
Review Floridas eligibility criteria, and if you believe you are eligible to enroll in Medicaid you have several options:
- Enroll at Healthcare.gov .
- Apply online at ACCESS Florida, or fill out a paper form. Use this application for low-income children, pregnant women, families, and aged or disabled individuals who are not currently receiving Supplemental Security Income .
- Use this application to apply for food or cash assistance in addition to Medicaid. You should also use this form if you currently receive SSI or if you are applying for home-based and community services, hospice care, or nursing home care.
- Submit a paper application submitted by mail, fax or in person to a local service center.
For help with the application process, call 1-866-762-2237.
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Unitedhealthcare Connected Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call , TTY 711, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al , TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
Los servicios Language Line están disponibles para todos los proveedores dentro de la red.
Medicaid Provider General Notice
Effective September 1, 2013, youth who reside in a Department of Juvenile Justice commitment program are not eligible for Medicaid services for the duration of his or her stay in the DJJ residential program. Therefore, no provider of Medicaid services may bill Medicaid for services or goods provided to a youth who is in a residential commitment program except for emergency medical treatment for non-citizen youth.
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Medicaid To Other Insurance Sources
The Urban Institute estimates that as many as one-third of children expected to lose Medicaid may have a parent with an offer of employer coverage. However, even if an employer offers coverage to dependents of employees, they may pass on a larger share of the added cost to the family, making it unaffordable. High cost-sharing and limits on benefits could make it harder for families to access all of the services they need. Similar to the marketplace, short enrollment windows outside of open enrollment can be another transition barrier.
Income Requirements For Florida Medicaid
There are income requirements for Medicaid in Florida. You need to earn an income that is within the federal poverty level for your group. This is calculated by a specific system that is known as the Modified Adjusted Gross Income, or MAGI.
Basically, before taxes, income needs to be under these amounts, according to Benefits.gov:
Household Size Maximum Income Level
1 $15,000
- Speech-language pathology, respiratory, physical, and occupational therapy services
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What Changes When A Woman Already Enrolled In Medicaid Becomes Pregnant
Generally, nothing. A woman who was previously eligible and enrolled in full-scope Medicaid who becomes pregnant continues to be eligible, and will be able to access pregnancy services. A woman who becomes pregnant while enrolled in Medicaid Expansion can stay in that coverage, at least until redetermination. The state must inform the woman of the benefits afforded to pregnant women under other coverage categories, such as pregnancy-related Medicaid, and provide the option to switch categories if the woman is eligible.
Provider Inquiry Newborn Spreadsheet
If you know the mother is pregnant, Medicaid eligible, and her unborn child does not have a number, you may have the baby added by emailing a password protected Master Unborn Provider Spreadsheet to the statewide DCF email address identified on the spreadsheet. This spreadsheet can also be used to contact DCF to request assistance regarding missing eligibility for newborns or issues concerning incorrect demographics such as discrepancies in dates of birth.
Please review the Provider Unborn Update Spreadsheet Completion Guide for further instructions on completing and submitting inquiries to DCF.
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History Of Floridas Medicaid Program
Florida was one of the later states to implement a Medicaid, not adopting the program until January of 1970 .
Florida Medicaid spending grew 13.5% on average every year between 1980 and 2004. In an effort to slow that trend, Florida applied for and received approval for an 1115 waiver for its Medicaid Reform pilot. The pilot implemented managed care in two counties in 2006 and added three more counties in 2007 the waiver was extended several times.
In 2013, the federal government approved an amendment for statewide expansion of managed care the amendment also renamed Medicaid Reform as Managed Medical Assistance . Ninety percent of all Florida Medicaid beneficiaries are now enrolled in managed care plans, like health maintenance organizations . The state hopes to improve quality through better coordination of care and save money through smaller networks of providers.
Part of the reason Medicaid enrollment has grown is the extensive outreach on the part of ACA navigators some residents were already eligible for Medicaid or CHIP prior to 2014 , but werent aware of their eligibility until enrollment outreach efforts under the ACA. But since Florida hasnt expanded Medicaid, the newly insured population is covered according to the normal state/federal split.
Floridas decision not to expand Medicaid leaves nearly 400,000 people in the state in the coverage gap ineligible for Medicaid and also ineligible for tax subsidies to help them afford private health insurance .
American Disabilities Act Notice
In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.
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Figure 3 Strategies To Reduce Procedural Disenrollments
- Improve automatic renewal rates
- Boost eligibility and call center workforce capacity
- Increase funding for community-based outreach and application assistance
- Send follow-up notices and reminders when action is required
- Maximize use of communication modes
- Expand the ways enrollees can submit needed information either verbally or electronically to replace the inefficiency of processing paper documentation
- Work with Medicaid managed care organizations and health care providers to update contact information and remind members that their renewal is due
- Ensure that call centers have adequate, trained staff to avoid call wait times that impede families from getting assistance
Workforce capacity dictates how quickly states can complete outstanding work. Like many employers, state eligibility agencies have experienced challenges in retaining and recruiting eligibility workers. Staff hired in the past two years are not experienced in processing renewals, and even workers with more tenure need refresher training. States can supplement workforce capacity by approving overtime, bringing retirees back, hiring temporary staff, and using contractors to handle certain administrative tasks. But these steps require adequate budgets and authority for agencies to take action.
No Aca Medicaid Eligibility Expansion In Florida
Florida is one of 12 states that has not expanded Medicaid eligibility as allowed under Affordable Care Act . The ACA doesnt provide subsidies for people with income below the poverty level, because the law called for them to have Medicaid instead. But in states that have refused Medicaid expansion people who arent eligible for Medicaid and whose income is too low for exchange subsidies are in whats called the coverage gap.
Federal
Floridas eligibility standards are:
- Children up to 1 year old: 206% of the federal poverty level
- Children ages 1-5: 140% of FPL
- Children ages 6-18: 133% of FPL
- Pregnant women: 191% of FPL
- Adults with dependent children: 27% of FPL
People who qualify for Supplemental Security Income automatically qualify for Medicaid in Florida. See more information in the SSI-Related Programs Financial Eligibility Standards.
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Will A Marketplace Health Plan Also Cover A Newborn
Yes. The ACAs EHB requirement mandates coverage of maternity and newborn care. Newborn care covers childbirth and immediate care for the baby after birth. The specifics of this coverage will vary by state and by each individual plan, but all women in Marketplace coverage must also enroll their baby in coverage soon after birth.
If the newborn is eligible for Marketplace coverage, then the parents can choose to add the baby to the familys existing Marketplace plan or choose a new Marketplace plan for the baby. If they opt for the latter, they can enroll the baby into a new Marketplace plan at any metal tier. However, when enrolling a newborn into Marketplace coverage, other members of the household are generally not permitted to change their existing Marketplace coverage.
Member Forms & Resources
Notice of Privacy Practices
We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it.
You can download a copy of our Notice of Privacy Practices below.
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PDF 126.63KB – Last Updated: 11/12/2020
Health Plan Performance Measures
View the Agency for Health Care Administrations website where you can view our health plans performance measure results and compare with those of other health plans.
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PDF 1.36MB – Last Updated: 04/06/2021
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How Do I Apply For Wic
* Note: Use the WIC Prescreening Tool to see if you might be eligible for WIC. Prescreening Tool is available in multiple languages.
To apply for WIC, contact a local WIC office. or call 1-800-342-3556 and ask for the phone number of your local WIC office.
The local WIC office will give you an appointment to see if you are eligible for WIC. At this visit, your household income and the medical/nutrition status of each applicant will be reviewed.
Florida Has Not Accepted Federal Medicaid Expansion
- 4,956,941 Number of Floridians covered by Medicaid/CHIP as of September 2021
- 1,378,000 Number of additional Florida residents who would be covered if the state accepted expansion
- 415,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
- $6.6 billion Federal money Florida is leaving on the table in 2022 by not expanding Medicaid
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Do Marketplace Health Plans Provide Women With Comprehensive Coverage Including Maternity Care
Yes. All Marketplace plans must include the ten Essential Health Benefits , one of which is maternity and newborn care. HHS has not specified what must be covered under this category, delegating that authority to the states. Thus, specific benefits covered under maternity care vary by state.
2. What changes when a woman enrolled in a Marketplace plan becomes pregnant?
Nothing, unless she wants it to. The woman may choose to remain in a Marketplace plan or, if eligible, to enroll in Medicaid or CHIP. The woman will not lose eligibility for the APTCs as a result of access to MEC through full-scope or pregnancy-related Medicaid, but cannot be enrolled in both simultaneously and thus must choose. In deciding which coverage to select, overall cost, access to preferred providers, impact of transitioning across plans, and effect on family coverage influence preference.