• 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.

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.

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

Website