Florida Medicaid Eligibility Phone Number For Providers – Advocate’s Guide to Florida Long-Term Care Medicaid Waiver July 2022 (5th Edition)

It provides a road map for a complex Medicaid program that provides home and community services to frail elderly and disabled Floridians who want to leave a nursing home after they can no longer manage the routines of daily life.

Table of Contents

1. Florida Medicaid Eligibility Phone Number For Providers
2. Florida Medicaid Provider Enrollment Application
3. Advocate’s Guide To Florida Medicaid
4. Medicaid Florida Exceptional Claim Form
5. Some Floridians Will Unintentionally Lose Their Medicaid Benefits Starting April 1, 2023
6. Florida Medicaid Education Materials
7. Florida Medicaid Provider Supplemental Wage Agreement
8. Florida State Medicaid Managed Care
9. Florida Medicaid Eligibility & Coverage
10. Provider Communication Bulletin #119

Florida Medicaid Eligibility Phone Number For Providers

The guide provides advocates with an overview of the Florida government’s medicaid long-term care waiver and a road map that addresses basic questions, including: who is eligible; how to apply; to do if the application is rejected or delayed; how the waiting list works; What to do if services are denied, delayed, terminated or reduced.

Florida Medicaid Provider Enrollment Application

INDEX

Section Six: What if the application is rejected or delayed? – Section seven: Plan registration – Section eight: Change of plans / cancellation

– Section ten: What services are covered? – Section eleven: When must the covered services be provided? – Section 12: What are the standards of access and continuous coverage? – Section 13: What if services are denied, delayed, reduced or terminated?

Section Fourteen: Other Advocates / Consumer Resources – Section Fifteen: Relevant Authority Books – Appendices – Notes

Advocate’s Guide To Florida Medicaid

Acknowledgments

They must be updated regularly: laws change, regulations change, waiver documents are updated, care contracts change. We are therefore very grateful to Naomi Stanhaus and the RRF Foundation of Siena, whose generous support has made just this renovation possible.

We are also very grateful to the Alliance for Seneca and the RRF Foundation for Aging for consumer-based video production

We are very grateful to Lara Kimmel, whose careful attention to editing and careful checking has been absolutely invaluable and diligent.

Medicaid Florida Exceptional Claim Form

We are very grateful to Jay Jefferson for the great work he involved in creating the new web-based version.

, among “Legal Tips”. We are grateful to Alliance on Aging, Inc., the Area Agency on Aging for Miami-Dade and Monroe counties, whose generous support has allowed us to meet with local providers who serve older residents who require home services. We are also very grateful to the Allicencia staff for their time and expert input. Together with community providers, their expertise and real-world experiences were essential to doing so

As a useful and most relevant tool. We are also very grateful to the staff from both the Florida Medicaid Agency and the Florida Department of Senior Affairs who

And significant feedback provided. As attorneys, we can provide analysis and citations to the many sources of Florida government exemption authorities, but there is no substitute for the daily experience of helping frail and disabled people with services to help them live safely at home. ‘T may remain’ We are also very grateful to the Federation for Seneca and the RRF Foundation for Seneca, based on supporting sustainable consumer video production.

Some Floridians Will Unintentionally Lose Their Medicaid Benefits Starting April 1, 2023

Thanks also to the legal scholars who helped the most with the preparation of the 2nd and 3rd editions

We are very grateful to Jay Jefferson for the great work he did on the new version of the text, Nancy Leichter for her careful proofreading; and Melissa Lipnick whose help was absolutely invaluable.

We would like to thank Nancy Wright, Florida State’s leading expert on Medicaid long-term care waivers and Eric Carlson, Director of Attorneys for Justice on Aging, and leading national expert on Medicaid long-term services and supports in the home and community. Based on Waivers.- Not only is this guide possible thanks to his previous work, but he also spent hours reviewing and editing our drafts.

We would also like to thank our authors Jocelyn Armand, Director of Legal Advocacy for the Greater Miami Office, and Michelle Adams for their invaluable help and support in preparing the guide. ,

Florida Medicaid Education Materials

Thanks also to Valory Greenfield, staff attorney at the Bay Area Legal Services Florida Senior Legal Helpline, and Anna Swerlick, Florida Medicaid expert and health policy analyst at the Florida Policy Institute, who advised on making the guide more useful to Florida’s senior serving attorneys. which needs a long time. -time benefits and allowances; and Joseph Schieffer of A2J (Access to Justice) and Alison DeBelder of the Florida Justice Technology Center, who helped share this resource with the Florida advocacy community.

Finally, we are very grateful to Sarah Halsell, State Legal Services Developer at the Florida Department of Seniors (DOEA). Sarah’s commitment to providing critical resources available to Florida attorneys, along with financial support from the US Community Living Administration’s model of access to public legal aid systems, has made it so.

Section I: Introduction

Needless to say, maintaining health care is critical for low-income Florida seniors — especially the frail and disabled.

Florida Medicaid Provider Supplemental Wage Agreement

Care is among the most important health services for this population – the long-term services and supports (“LTSS”) that are necessary to remain at home or in the community rather than receiving care in a nursing home. Also known as “home and community-based services” (“HCBS”), these include services not available through Medicare or Medicare, such as personal care and private nursing care. Nationally, more than half of people who turn 65 will at some point develop a serious disability or medical condition that will require HCBS.[1]

In Florida, HCBS is available for adults under the state’s Medicaid Managed Care system. Long-term care – including both nursing home care and HCBS – are both part of Florida’s “Long-Term Care Program.” [2] This government only looks at the portion of the HCBS program that provides HCBS, (LTC. ) waivers. “) While the LTC waiver has a limit on the number of people on the payroll and waiting list for enrollment, [3] this should not deter individuals from applying.

Provides advocates with an overview of Florida’s Medicaid governing authority for Long-Term Care (LTC) waivers and a roadmap that addresses key issues, including:

Section Two: Maecenas of life

Florida State Medicaid Managed Care

Under waiver programs, states can “drop” certain requirements under the Medicaid Act with the consent of the federal government. For example, waiver programs allow states to provide care to people who would otherwise be ineligible under Medicaid; to provide services that are not necessarily medical in nature, or to implement a managed care system. The current long-term care waiver operates through two separate waivers under the authority of the Social Security Act, sections 1915(b) (for managed care) and (c) (HCBS)).

Section 1915(c), which authorizes Medicaid HCBS waivers, was passed by Congress in 1983. HCBS waivers allow states to provide home and community support to an individual number as an alternative to institutional care. [4] All individuals enrolled in HCBS waiver must meet institutional care.

To facilitate these programs, the federal government can stop the general rules of Medicaid, which programs are available across the state (statewide) and to all eligibility groups (comparability), and also provide easier financial eligibility standards.[6] Section 1915(b) of the Social Security Administration provides the authority for states to require enrollment in managed care, omitting rules that allow providers to freely choose benefits.[7]

Because states are allowed to limit enrollment in HCBS waivers, [8] eligible individuals who meet the economic and financial eligibility requirements for HCBS may nevertheless be placed on the waiting list. On the other hand, similarly qualified persons seeking placement in nursing homes cannot be placed on the waiting list.

Florida Medicaid Eligibility & Coverage

In 2011, the Florida legislature established a statewide managed care program covering all services, including long-term care. The new statewide program includes a managed medical assistance (MMA) program designed to provide primary and acute medical care, and to manage long-term care (“LTC”) care.[11]

Under the managed care delivery model, the state contracts with private entities, including managed care organizations, to “manage” the health needs of their loved ones using their network of providers. These Managed Care Organizations (hereafter referred to as “Councils”) act as gatekeepers to approve services and are referred to network providers for covered services.

After the public comment period, the Agency for Health Care Administration (AHCA) submitted two waiver applications to the Centers for Medicaid and Medicare (CMS), the federal agency responsible for administering Medicaid. In 2013, CMS announced approval under both provisions of HCBS through the State Medicaid Long-Term Care Program (hereafter the “LTC Waiver”).

In 2016, the AHCA required a five (5) year renewal of both the 1915(b) and (c) waivers to continue its LTC waiver.

Provider Communication Bulletin #119

On April 1, 2022, CMS approved the renewal requests, with the annual approval of a non-duplicated number of assets of 105, 111 in year one (1) waiver and increasing each year through the middle of 2 waivers.

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