The Medicaid program and the related Children’s Medical Insurance Program (CHIP) provide healthcare coverage to over 60 million people across the country. Both programs are run as partnerships between individual states and the federal government. Florida, as well as the other states, has established its own Medicaid program, administering it as well as determining the scope of services covered. These state Medicaid programs must cover mandatory benefits and offer coverage to certain population groups in order to be approved by the federal Centers for Medicare and Medicaid Services (CMS).
Of the 3.3 million Florida residents enrolled in a Medicaid program, about 64% receive coverage through a managed care program where the state contracts with a private health insurance company to deliver medical benefits. In August of 2013 Florida began transitioning to a system that provides 100% of Medicaid coverage through managed care programs. The managed care transition means that Florida will be responsible for paying private health plans to coordinate healthcare for Medicaid recipients. The state requires that health plans spend at least 85% of premiums on healthcare and 15% on administrative costs and profits.
During the first phase of the transition, long-term care recipients, typically seniors residing in nursing homes or assisted-living communities, are required to select a managed care plan by December 1, 2013. The state’s Department of Elder Affairs will monitor the performance of managed care plans for at least two years following the transition. All Medicaid beneficiaries are expected to move to a managed care program by the fall of 2014.
In order to be eligible for Florida Medicaid, applicants must be US citizens or Qualified Aliens, must be Florida residents and must provide Social Security Numbers and proof of identity. Applicants must disclose all forms of income and assets and a determination on eligibility will be made within 45 days of receipt of the application.
In the state of Florida the Agency for Health Care Administration (AHCA) is responsible for overseeing Medicaid. It is partnered with the Department of Children and Families (DCF), which determines Medicaid eligibility for the following populations:
- Low income families with children
- Children only
- Pregnant women
- Non-citizens with medical emergencies
- Aged and/or disabled individuals not currently receiving Supplemental Security Income (SSI)
The Children’s Medical Insurance Programs (CHIP) is part of a program called Florida KidCare that offers a variety of healthcare services for Florida children. CHIP enrollees are usually children whose families do not meet the income requirements for Medicaid but cannot afford to pay for private healthcare. Florida children up to age 18 and their families may be eligible for Medicaid if the family’s annual income is under a certain threshold and their countable assets are not above $2,000.
The Medically Needy program is available to Florida residents who are not eligible for "full" Medicaid because their income or assets are over the Medicaid program limits. This is a “share of cost” program, meaning that individuals that incur medical bills over a certain threshold in a month could be eligible for financial assistance from the Florida Medicaid program.