A Software Glitch Is To Blame As Payment Problems Resulted In Families Not Being Able To Pay For Nursing Care And Other Home Health Services For Nearly Three Months
Florida failed for nearly three months to pay tens of thousands of health-care claims for the state’s sickest and neediest children due to software glitches blamed on the corporate merger of its two largest payment vendors, officials and executives said.
Families with critically ill children who relied on Medicaid-paid health providers were stranded in some cases. A father in Lake Worth was forced to cut back his contractor work to remain home and care for his son when payments stopped. A mother in Ocala said the company that helped care for her 15-year-old disabled son temporarily shut down because of the payment problems.
We had to find caregivers for him, said AnnMarie Sossong of Ocala, whose son has a neuro-immune condition and profound autism. You cant do anything else. You can’t go to work, you can’t go to school, you can’t even make a phone call because you’ve got this kid with such high needs, she said.
Payment problems panicked more families, especially as unpaid bills for nursing care and other home health services began stacking up over months with no quick resolution in sight.
It was among the most serious technology meltdowns affecting one of the most vulnerable populations under the administration of Gov. Ron DeSantis since unemployment claims overwhelmed Florida’s Department of Economic Opportunity early in the pandemic.
Frustrated families said they did not blame their childrens health providers who werent being paid.
Cms Plan Transition To Wellcare
Jan 3, 2019 | News
Information about CMS Plan Transition to WellCare
In December, several practices/health systems received a notice of termination of their contracts with the University of Florida for participation in the Ped-I-Care provider network. Additional information from CMS that may answer some common questions from providers and families is provided below.
The Ped-I-Care members always were and will continue to be members of the Childrens Medical Services Managed Care Plan a/k/a the CMS Plan for both Title 19 and for Title 21. Ped-I-Care, a program of the University of Florida, was an administrator for the CMS Plan. Ped-I-Care provided utilization management services, provider compliance services, member services for the CMS children, and contracted for network providers, so, as an administrator for the CMS Plan, Ped-I-Care interacted with practices on many different levels and in many different areas over the years.
Early And Periodic Screening Diagnosis And Treatment
EPSDT provides a comprehensive array of prevention, diagnostic, and treatment services for low-income infants, children and adolescents under the age of 21 years, as specified in Section 1905 of the Social Security Act and defined in 42 U.S.C. Â§ 1396d and 42 CFR 441.50 or its successive regulation.
The EPSDT benefit is more robust than the Medicaid benefit for adults and is designed to assure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible.
Health plans are required to comply with all EPSDT requirements for their Medicaid enrollees under the age of 21 years.
EPSDT entitles Medicaid enrollees under the age of 21 years, to any treatment or procedure that fits within any of the categories of Medicaid-covered services listed in Section 1905 of the Act if that treatment or service is necessary to correct or ameliorate defects and physical and mental illnesses or conditions. This requirement results in a comprehensive health benefit for children under age 21 enrolled in Medicaid
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Learn About Chip In Florida
Florida Childrens Health Insurance Program helps provide over 430,000 children in the state with health care coverage. While CHIP and Medicaid enrollment serve similar purposes, the two programs are not the same. Starting in 1997, CHIP has ensured that children could still have health coverage even if from low-income households not eligible for Medicaid. This means that even if adult members in a family do not have Medicaid eligibility children from that household can still be eligible for CHIP. Medicaid for children in Florida has different enrollment practices than the standard request for Medicaid. Learn how to apply for CHIP in Florida and more details about the program in the information below.
What is Floridas Childrens Health Insurance Program?
Many may wonder, What is CHIP Medicaid? when inquiring about the government program. The Florida Childrens Health Insurance Program, like the Medicaid program, is part of the federal Social Security Act and offers coverage for qualified applicants. Each state manages its CHIP program differently and requirements for Medicaid eligibility for children may vary. Florida KidCare is the name of the four Childrens Health Insurance Programs in the state.
Learn more about benefits available to CHIP enrollees and how to apply to the program in our free guide.
Is CHIP considered Medicaid in Florida?
Who qualifies for CHIP in Florida?
What services are covered by CHIP in Florida?
How to Apply for CHIP in Florida
Apply For Florida Kidcare
Your application for Florida KidCare is used to determine which of the four programs under its umbrella is best for you you dont need to fill out individual applications for each program.
To complete the online application you will need:
- Social Security Numbers
- Employer and income information for everyone in your family
- Policy numbers for any current health insurance
- Information about any job-related health insurance available to your family and
- Additional documents, if needed.
- Email it to or
- Mail it to Florida KidCare, P.O. Box 591, Tallahassee, Florida 32302-0591.
Florida Healthy Kids will mail you a response in writing. If you are not satisfied with the result you can send a second dispute to Senior Management at the Florida Healthy Kids Corporation.
If you are still not satisfied with the result, you can send your dispute to the Agency for Health Care Administration at 2727 Mahan Drive, Tallahassee, FL 32308. You can also reach the AHCA at their toll free number: .
If you have an issue with the quality, availability, or billing of medical services your child has received you must file an appeal through your insurance plans provider. KidCare providers may have some differences in their appeals process but they all must conform to state guidelines set by the AHCA.
If you have had benefits or services denied or terminated by Florida KidCare or one of their partnered providers contact CLSMF for legal advice.
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Rep Castor Led The Florida Democratic Delegation In Urging Gov Desantis To Prioritize Keeping Children Enrolled In Health Insurance
Today, U.S. Rep. Kathy Castor led all Florida Congressional Democrats in urging Governor Ron DeSantis to ensure that Florida does not see an unnecessary and harmful increase in children without health coverage when the public health emergency ends. Congress acted during the Covid19 pandemic to ensure that individuals on Medicaid would not lose health coverage, but as we emerge from the pandemic, all states must prepare and work to ensure children stay connected to a pediatrician and health care. Florida currently has 2.7 million children enrolled in Medicaid and the Childrens Health Insurance Program , with at least 400 thousand children under 18 gaining coverage since March 2020.
It is critical that Florida begin making plans now to prevent a mass disenrollment of children from their health insurance at the conclusion of the public health emergency, the Members wrote. We look forward to working with you to meet our shared goal of keeping Floridians healthy and enrolled in high-quality coverage.
The letter can be found here.
Local and national health leaders joined the Members in urging Governor DeSantis to prioritize the health of Floridas children and start planning now to ensure continuity of care:
Childrens Medical Services Managed Care Plan
CMS plans were developed to provide quality insurance to children with special health care needs. Benefits for children enrolled in CMS include:
- A care coordinator to help the child and their family navigate the health system
- Medically necessary, high quality services
- Access to a wide-range of primary, specialty and facility providers throughout Florida
- Education on preventive health services and disease management and
- Timely processing of provider requests for service authorizations and payments.
There are two separate versions of the Childrens Medical Services plan one though Medicaid and the other through Florida KidCare. Both versions require that the child is eligible for the related program, is under a certain age , and has special health care needs that require extensive preventive and ongoing care. Medicaids CMS plan does not require a premium, while Florida KidCares version does.
CMS is administered by the Florida Department of Health, who has partnered with Wellcare to provide services.
Children must meet Childrens Medical Services clinical screening requirements or have a physician attest to childs qualifying medical conditions.
Your monthly premium will be decided by your family size, income, and other factors.
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Looking For The Childrens Medical Services Managed Care Plan
In an effort to better serve our families, providers and visitors, the Office of Childrens Medical Services Managed Care Plan has moved to its own dedicated website. If you are looking for information previously contained in the Managed Medical Assistance tab or any information related to the CMS Managed Care Plan, which offers a coordinated system of care for children with special health care needs, please visit our new website at CMSPlan.floridahealth.gov. On the new CMS Managed Care Plan site, you will find information regarding the Plan, including eligibility and services, updates and events as well as specific information for members and providers.
This website will continue to serve as the site for the Division of Childrens Medical Services and will still provide information about CMS programs such as Child Protection, Newborn Screening and Early Steps, but all information pertaining to the CMS Managed Care Plan can be found on the new site.
|This page was last modified on: 06/15/2020 10:56:44|
Children’s Medical Services Health Plan
Welcome to Children’s Medical Services Health Plan .
This plan is for children with special health care needs. It provides a comprehensive system of care that’s centered around the family.
CMS Health Plan has partnered with WellCare of Florida, Inc. to provide managed care services to our members. WellCare is a licensed Florida health plan.
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Coverage For Florida Children
Florida children from birth through the end of age 18 are eligible for coverage. It is free to apply and with year-round enrollment, the time to apply is always now. Begin your familys application by clicking the pink Apply Now button. Then Florida KidCare does the rest. Based on the age of the child, household size, and family income, we automatically match each child with their best fit of the four Florida KidCare programs Medicaid, MediKids, Florida Healthy Kids, or the Childrens Medical Services Health Plan. Its that easy!
Childrens Medical Services Managed Care Plan Considerations
Along with their Managed Care Plan, CMS also offers specialty programs which are designed to focus on specific medical issues a child is facing. To read more about these programs go to .
When you choose the CMS plan through KidCare you have 90 days to decide if you want to change plans or dis-enroll. After this you are locked in and cannot change or dis-enroll until your annual renewal period 1 year later. There are exceptions to this rule, including:
- Your childs doctor does not, because of moral or religious obligations, provide a service your child needs
- Your child needs related services to be done at the same time and your childs primary care provider determines that receiving the services separately would subject your child to unnecessary risk, but not all related services are available in the plans network
- Your child has an active relationship with a healthcare provider who is not in the plans network, but who is in the network of another subsidized plan in the area
- The plan is no longer available in the area where your child lives
- KidCare requires the insurance company to take action to improve quality of care and
- Other reasons determined by KidCare, including, but not limited to, lack of access to services or providers with the appropriate experience to provide care to your child.
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Medicaid Well Child Visits
Well child visits include preventive and comprehensive services for eligible children birth through 20 years of age and children in the Medicaid program.
Good health starts with regular well child visits ! Regular doctor visits help to identify health problems before they become serious. Florida Medicaid follows the Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care. You can view the recommendations by clicking on the following link.
Is it time for your childs well child visit ? Call your child’s doctor today to schedule an appointment.
- No limit on approved services
- No wait list for services
- No total coverage limit on approved services
- No limit on the number of visits to the doctor, therapist, dentist, or any other Medicaid provider
- Services may need a referral or prior approval
- Services that are covered now may not be after your child reaches the age of 21