OPPAGA text logo with graphic of FL historic capitol
OPPAGA text logo with graphic of FL historic capitol

Agency for Health Care Administration

What is the purpose of the agency?

The agency's purpose is to assure better health care for all Floridians.  The Florida Legislature created the Agency for Health Care Administration as part of the Health Care Reform Act of 1992 (Ch. 92-33, Laws of Florida). The agency is responsible for administering the Medicaid Program, licensing and regulating health facilities, and providing information to Floridians about the quality of the health care they receive.  The agency's secretary is appointed by the Governor, subject to confirmation by the Senate.

What are the major program activities and services of the agency?

The Agency for Health Care Administration's major program activities are administered by two divisions.
  • Medicaid Health Care Services provides health care coverage to low-income individuals who meet Medicaid and Florida KidCare eligibility requirements.
  • Health Quality Assurance ensures quality health care services by licensing and inspecting health care facilities, investigating complaints against health care facilities, and working to ensure the integrity of Florida's Medicaid Program.  In addition, the agency operates the Florida Center for Health Information and Transparency, which is responsible for collecting, compiling, coordinating, analyzing, and disseminating health-related data and statistics.

How is the agency organized?

The agency has designated 11 service areas. Medicaid field offices within the 11 service areas serve Medicaid providers and beneficiaries. The agency's Tallahassee central office coordinates Medicaid and health care regulation policy. There are eight Health Quality Assurance field offices within the 11 service areas that offer quality assurance services and serve as local liaisons for providers.

How are these activities funded?

The majority of the agency's budget pays for direct health care services for Medicaid and KidCare clients. Another portion pays for health care regulation activities, such as licensing and inspecting health care facilities, providing consumer assistance, investigating complaints, and regulating managed care organizations.
Fiscal Year: 2020-21
Fund Dollars Positions
AGENCY FOR HEALTH CARE ADMINISTRATION
PROGRAM: ADMINISTRATION AND SUPPORT
32,199,912
255.00
PROGRAM: HEALTH CARE REGULATION
HEALTH CARE REGULATION
96,248,438
653.50
PROGRAM: HEALTH CARE SERVICES
CHILDREN'S SPECIAL HEALTH CARE
660,559,104
.00
EXECUTIVE DIRECTION AND SUPPORT SERVICES
297,552,769
621.00
MEDICAID LONG TERM CARE
7,022,194,939
.00
MEDICAID SERVICES TO INDIVIDUALS
22,317,451,019
.00
TOTAL
30,426,206,181
1,529.50

Updates

Federal COVID-19 Relief Funding for Medicaid and Children's Health Insurance Program (CHIP) providers and Safety Net Hospitals.  The U.S. Department of Health and Human Services (HHS), allocated relief funds through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act, to hospitals and other healthcare providers, including those disproportionately impacted by the COVID-19 pandemic. In addition, HHS allocated relief funds to eligible Medicaid and Children's Health Insurance Program (CHIP) providers.  The payment to each Medicaid or CHIP provider will be at least 2% of reported gross revenue from patient care; and the final amount each provider receives will be determined after provider data is submitted, including information about the number of Medicaid patients providers serve.  HHS also allocated funds to qualifying safety net hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care.  To qualify as serving a disproportionate number of Medicaid or uncompensated care patients, the hospital must have an average uncompensated care per bed of $25,000 or more; a profitability of 3% or less as reported in its Centers for Medicare and Medicaid Services Cost Report; a disproportionate payment percentage of 20.2% or greater.

 

The Agency for Health Care Administration is responding to COVID-19, and as of June 2020, its response to the global pandemic has included changes for long-term care providers and Medicaid providers and recipients.

Changes for Long-term Care (LTC) providers include:

  • providing support to and determining emergent needs of residential facility providers and extending deadlines for Intermediate Care Facilities and nursing home Quality Assessment Payments;
  • issuing emergency rules granting the Department of Health or their authorized representative access to nursing homes and assisted living facilities for infection prevention and control, including mandated COVID-19 testing of both on-duty and off-duty staff, and requiring hospitals to test all patients, regardless of symptoms, prior to discharge to LTC facilities;
  • requiring nursing homes to transfer residents with verified or suspected COVID-19 cases if they cannot be appropriately isolated; and 
  • expanding provider qualifications for LTC services to allow additional providers to render services when there are workforce shortages, location closures, etc.  

 Changes for Medicaid providers and recipients include:

  • extending Medicaid recipient eligibility and time to complete the application process;
  • waiving prior authorization requirements for Medicaid hospital services (including LTC hospitals), physician services, advanced practice registered nursing services, home health services, nursing facility services, and durable medical equipment and supplies, as well as co-payments for services;
  • waiving prior authorization requirements for all services necessary to appropriately evaluate and treat Medicaid recipients diagnosed with COVID-19 and adding coverage for COVID-19 lab test codes;
  • waiving authorization limits for Medicaid services to maintain the health and safety of recipients diagnosed with COVID-19 or when it is necessary, and allowing early refills and 90 day supplies of maintenance drugs; 
  • expanding telehealth services for Medicaid fee-for-service and expanding telehealth coverage services including behavior analysis, therapy, and specific behavioral health services; and
  • prohibiting Medicaid managed care plans from applying pre- and post-payment reviews on services claims in which prior authorization requirements have been waived unless certain criteria are met.

Where can I find related OPPAGA reports?

A complete list of related OPPAGA reports is available on our website.

Where can I get more information?

Other Reports
The Auditor General reports on agency operations are available on its website.
Websites of Interest
Florida Health Finder
Florida Health Information Network (FHIN)
Performance Information
Performance measures and standards for the department may be found in its Long Range Program Plan.

What are the applicable statutes?

Section 20.42, Florida Statutes.

Whom do I contact for help?

Consumer Call Center Complaint Hot Line, 1-888-419-3456

Website