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Florida Medicaid

Florida Health Information

Florida Medicaid

Medicaid is the federal and state partnership that gives health treatment for some people with low incomes. Its goal is to grow the health of people who might otherwise go without medical care for themselves and their kids. Medicaid is not the same in every state.

In Florida, the Agency for Health Care Administration (AHCA) creates and carries out policies associated to the Medicaid program. A explanation of the services offered by the Florida Medicaid program can be found in the Summary of Services, 2004-2005. Updated 12/13/04

Florida implemented the Medicaid program on begening of the year 1970, to give medical services to poor people. Over the years, the Florida Legislature has authorized Medicaid compensation for more services. A big grow happened in 1989, when the United States Congress mandated that states offer all Medicaid services allowable under the Social Security Act to children under the age of 21.

The state Medicaid plan is the document that defines how each state will operate its Medicaid program. Each state submits its own plan to the Centers for Medicare and Medicaid Services (CMS) for approval. The state plan addresses the areas of state program administration, Medicaid eligibility criteria, service coverage, and provider compensation. Follow this link for more information regarding Medicaid state plans.

Administration and Funding

The Medicaid program is administered by Florida's Agency for Health Care Administration (AHCA).

The Florida Medicaid program is authorized by Chapter 409, Florida Statutes, and Chapter 59-G, Florida Administrative Code.

The Medicaid program is funded through federal and state participation with Florida's counties contributing to inpatient hospital and nursing home services. Matching federal funds are contingent upon the state's continued compliance with Title XIX of the Social Security Act and regulations in Title 42 of the Code of Federal Regulations. The Medicaid budget for fiscal year 2003-04 is approximately $12.5 billion.

The Agency for Health Care Administration contracts with Health Management Systems, Inc. (HMS) to conduct the Medicaid Third Party Liability (TPL) Program. HMS is responsible for identifying additional sources of payments and recovering payments made by Medicaid from liable third parties. TPL includes three major components: Casualty (Tort) Recovery, Estate Recovery and Other Third Party Insurance Recovery. TPL functions are described in Sections 409.910 and 409.9101, Florida Statutes.

Health Management Systems, Inc. (HMS) currently conducts Medicaid Third Party Liability recovery for the State of Florida. For TPL recovery information, visit their web site at http://www.flmedicaidrecovery.com or call toll free (877) 446-7868 for questions regarding Casualty Recovery, Estate Recovery, Other Third Party Insurance Payer, Insurance Denials or Insurance Carrier Code Information. For questions regarding Reimbursement for Medicaid Providers or Other Recoupment Projects, call the HMS Provider Relations Unit toll free (888) 831-2738.

Beneficiary Services

Do you need to know what services Florida Medicaid covers?
Do you need to know who provides Florida Medicaid services?
Do you need help with information and referral?
Do you need help with medical bills you are receiving?

Florida Medicaid Beneficiary Services can assist anyone who is receiving Medicaid. You can call or have a family member call for you. Services are free. Your records are confidential, except for the purpose of administering the program. For more information regarding these services, call the Area Medicaid Office that serves your county.

Miami-Dade & Monroe Counties

Okaloosa and Walton Counties
1-800-303-2422, Ext. 263

Franklin, Gulf, Holmes, Jackson and Washington Counties

Taylor and Liberty Counties Only

Volusia, Baker, Clay, Flagler, Nassau and St Johns Counties

Pasco County
1-800-299-4844, Ext. 276

Hardee, Highlands, Manatee and Polk Counties
1-800-226-2316, #4

Fiscal Agent Procurement

The State of Florida Agency for Health Care Administration (AHCA) is in the process of procuring a fiscal agent to meet the requirements of the Florida Medicaid program beginning July 1, 2007.

Point of Contact

The State has designated the following person as the Issuing Officer and sole point of contact for this procurement:

Angela Smith
Issuing Officer
2727 Mahan Drive, Mail Stop 56
Tallahassee, FL 32308

Restriction on Communication

In fairness to all vendors, those vendors that may intend to submit a proposal for this contract, as primary contractor or as a subcontractor in any capacity, must now direct all communication related to the procurement or to fiscal agent services during the term of the proposed contract to the State’s designated point of contact. Sales presentations and lobbying efforts related to this procurement are expressly prohibited, except as allowed as part of the formal procurement process.

Current Status

The State has posted the Request for Proposal (RFP) that describes State requirements in detail. Follow this link to the Department of Management web site to download the documents. Some of the highlights of the requirements are:

  • Installation of a system new to Florida (not a takeover of the existing system).
  • Development of a combined FMMIS/DSS that meets business functional requirements under a Medicaid Information Technology Architecture (MITA) structure of organization.
  • Relational databases and Web-based architecture throughout FMMIS/DSS.
  • Real-time or near real-time processing.
  • Use of rules engines, workflow management engines and other tools that can be applied across components to manage recipient enrollment, provider administration, claims processing and other functions.
  • Use of appropriate subcontracts to handle specialized business functions such as health outcome reporting, Pharmacy Benefits Management, Decision Support, rate-setting, and fraud and abuse detection and control.
  • For every function, employ best-of-breed software, tools, methods, and subcontracts to apply current, proven solutions.
  • Use of Commercial-Off-The-Shelf (COTS) software to lower costs and to provide more flexible and efficient management.
  • Web-based claim submission, eligibility verification, reference materials and public information.
  • Implement a Benefit Plan structure with the flexibility to quickly and accurately add new service plans and implement requirements of Florida Medicaid reform.
  • Receive and process encounter data from managed care organizations and determine sound fee schedules based on many criteria.
  • Significant increases in automation and efficiency, and better integration with computer systems operated by trading partners, providers, and government agencies.
  • Significant improvement in administrative and status reporting.
  • Develop and implement an Electronic Health Record during the term of the contract.


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