Q and A

Medicaid Options

							        Q & A
							       

What is Medicaid Options? Medicaid Options is Florida's Medicaid managed care enrollment program. Qualified beneficiaries enroll through the toll-free Medicaid Options HelpLine to receive their health care services.
Why do I have to enroll in a plan? Florida Law (Florida Statute 409.9122) requires that most Medicaid beneficiaries choose some type of managed care option. Medicaid feels that your care will be better coordinated and you will have better access to appropriate care through a managed care option.
Does your child have special health care needs? Does your child have a medical, behavioral or other health care need that has lasted or is expected to last at least 12 months? If so, your child may be eligible for the CMS Network, a program for children with special health care needs. If you answer YES to any one of the questions below, you should call your local CMS Network office to find out if your child is eligible for the CMS Network.
1.	Is this child limited or prevented in any way in his or her ability to do the things most children of the same age can do?
2.	Does this child need to get special therapy, such as physical, occupational or speech therapy; or counseling for an emotional, developmental, or behavioral problem?
3.	Does this child need or use more medical care, mental health or educational services than is usual for most children of the same age?
Enrollment into CMS Network can only be done through a CMS office. To find a CMS office near you, click here.
Are there any fees for services (co-payments)?
	There are no co-payments for any child under age 21.
	Emergencies and family planning services do not require a co-payment.
	There are no co-payments for people in Medicaid HMOs.
	In MediPass and PSNs, most adults have to pay a small co-payment ($1-$3) when they use a medical service.
Can a Federally Qualified Health Center (FQHC) be my PCP? Known as Community Health Centers, FQHCs offer services to Florida Medicaid beneficiaries. If an FQHC is in your community, it can be your PCP choice. Call the toll-free Medicaid Options HelpLine to find out what plans the FQHCs work with.
Where can I get information on the Quality of Care each plan provides? Choosing A Quality Health Plan is a state report that compares HMOs on quality of care, and gives the results of a member satisfaction survey. For a copy of the report, view it online at www.FloridaHealthFinder.gov or call 1-888-419-3456. Access the agency's website to obtain MediPass information at: ahca.myflorida.com/Medicaid/MediPass/index.shtml
How do I receive my Outpatient Behavioral Health (Mental Health) Services? For HMO beneficiaries whose HMO manages Outpatient Behavioral Health (Mental Health) Services: If the doctor or mental health center is a plan (HMO) provider and the services are authorized by the plan, you may continue in your doctor's care. Please contact your doctor, mental health center or your plan Member Services number for additional information. You do not need the plan's approval for substance abuse services provided in a community setting (non-hospital setting). You DO need the plan's approval for hospital psychiatric and substance abuse services, unless those are emergency in nature. For HMO, PSN or EPO beneficiaries whose plan does not manage Outpatient Behavioral Health (Mental Health) Services: If the doctor is a plan provider and the services are authorized, you may continue in your doctor's care. If you go to a mental health center, ask the mental health center to coordinate your care with your primary care provider. You do not need the plan's approval to see a community mental health center provider. You do not need the plan's approval for substance abuse services provided in a community setting (non-hospital setting). You DO need the plan's approval for hospital psychiatric and substance abuse services, unless those are emergency in nature. For MediPass beneficiaries in Areas where the Prepaid Mental Health Plan (PMHP) manages Outpatient Behavioral Health (Mental Health) Services: You must receive your mental health services through the prepaid mental health plan, Florida Health Partnership. Please contact the local MediPass office or the Prepaid Mental Health Plan, Florida Health Partnership member services number for assistance. For MediPass beneficiaries in Areas where the Prepaid Mental Health Plan (PMHP) does NOT yet manage Outpatient Behavioral Health (Mental Health) Services: You may continue to receive your outpatient mental health services from any Medicaid provider of your choice.

To enroll, call the toll-free Medicaid Options Help Line:
1-888-367-6554 8 a.m. to 7 p.m. EST Monday - Friday
TDD users ONLY call, 1-800-653-9803
Sponsored by Florida's Agency for Health Care Administration