Florida Medicaid Primary Care Providers

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Unitedhealthcare Senior Care Options Plan

Medicaid expansion in Michigan: What primary care providers say

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Unitedhealthcare Community Plan Medicaid

Are you ready for flu season?

Influenza, commonly called the flu, is a serious illness that can spread easily. It can lead to missed days at school or work, and even hospital stays. Heres the good news: a simple shot can reduce your chances of getting influenza and its available to you at no cost with your UnitedHealthcare Community Plan. Talk to your UnitedHealthcare network doctor about getting the flu shot.

If you dont have one, please contact Member Services at and a representative can help you find one.

I Would Like To Change My Health Or Dental Plan

Change Health or Dental Plans Online

Log in to the FL Medicaid Member Portal to change your Health or Dental Plan. We will walk you through the process of changing your plan.

Why should you sign up for a FL Medicaid Member Portal account?

  • You can check your Medicaid eligibility and enrollment status
  • View and update your address
  • Request help using secure messaging
  • Enroll in a plan or change plans
  • File complaint and see what is happening with your complaint
  • Go paperless. Choose to only get letters from Medicaid electronically
  • Receive email or text message alerts

Other Ways to Change Your Health or Dental Plan

If you are unable to change Health or Dental Plans online at this time, there are several other options available to you.

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Unitedhealthcare Connected For Mycare Ohio

UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

What Is A Primary Care Doctor

A natural approach to family health

Your primary care provider may be a physician , nurse practitioner, clinical nurse specialist or physician assistant. They practice general health care, addressing a wide variety of health concerns for patients. They are usually the first point of contact if you have a health concern. They want to build a trusting relationship with you as your long-term family provider.

You might visit a PCP for:

  • Annual wellness visits
  • A referral to a specialist
  • Blood pressure, blood sugar and cholesterol tests
  • Early detection of conditions and illnesses
  • Flu shots and immunizations
  • Preventive care
  • Treatment for common illnesses

Primary care providers offer personalized guidance in managing a number of common issues and conditions such as:

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Staywell Opens Doors To Valuable Coverage

Staywell Health Plan provides health care and long-term care services to people who qualify for Florida Medicaid. Floridas Medicaid program is called the Statewide Medicaid Managed Care Program.

Staywell offers the following types of plans in the SMMC program:

  • Managed Medical Assistance : Provides health care services like doctor visits and emergency care and covers prescription drugs
  • Long-Term Care : Provides long-term care services, such as nursing facility services and home and community-based services. Contact the Department of Elder Affairs Aging and Disability Resource Centers to complete the screening. Learn more about Staywell’s Long Term Care Plan.
  • Specialty: Similar to MMA, but with specialized care for members with serious mental illness . Learn more about Staywells Specialty Health Plan.

Some members have both MMA and LTC plans. This means that Staywell covers both health care and long-term care services for these members.

Staywell also offers valuable programs and support. This includes extra benefits.

If you are Staywell member, please review the member handbook. The handbook will help you understand how the plan works. It will also let you know what services are covered.

While More Than 27 Million Floridians Signed Up For Health Insurance Coverage During The Recent Open Enrollment Period Questions About Accessibility Remain As The State Is One Of The Few That Has Not Expanded Medicaid Eligibility

The Centers for Medicare and Medicaid Services reported a record 14.5 million Americans either signed up for or re-enrolled in individual health insurance coverage during the recent open enrollment period.

According to the same report, Florida tops the nation with more than 2.7 million people signed up an increase of 600,000 from the previous year.

The Affordable Care Act, also known as Obamacare, was signed into law by President Barack Obama on March 23, 2010. Since then, it has provided health insurance to uninsured citizens nationwide through subsidized private plans and expanded Medicaid.

Jodi Ray is the director for Florida Covering Kids and Families at the University of South Florida College of Public Health.

She says one reason for the jump may be the Biden administrations push for more resources towards marketing and outreach, particularly through the $1.9 trillion American Rescue Plan.

As a result, the U.S. Department of Health and Human Services was able to put more public service announcements and other resources out to the public to make sure they were informed about the change in length of the open enrollment period.

We were extended out to January 15 this year as opposed to December 15, which was an extra month for people to sign up, said Ray.

Ray also explained that the most important thing is making sure consumers know where to go to get free help from a healthcare navigator in Florida.

Its not free to not expand Medicaid, she said.

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Reasons For State Action Against A Provider

Section 409. 913 sets forth the many reasons that the state may take action against a provider:

Section 59G-9.070 Administrative Sanctions on Providers, Entities, and Persons of the Florida Administrative Code, sets forth the required sanctions for each of these offenses, which are imposed in addition to the recoupment of any overpayment.

Do You Have Questions

Humana Florida Medicaid Associates Address Member Concerns During COVID-19

We are happy to help you. Call Staywell toll-free at 1-866-334-7927 , MondayFriday, 8 a.m.7p.m.

You can visit us too! We have Welcome Rooms throughout the state of Florida. Representatives are there to answer your questions. They can help with things like:

  • Updating your address
  • Changing your Primary Care Provider
  • Ordering over-the-counter items and more

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American Disabilities Act Notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Florida Termination And Sanction Lists

Exclusion actions in Florida, unlike other states that closely mirror federal law, is founded upon a complex set of legal authorities that are captured in multiple statutes. Checking Florida exclusion lists can be equally daunting. There are actually two lists that need to be reviewed. Florida maintains lists of both providers who have been financially sanctioned by the state as well as provides who have been terminated for cause from participation in Floridas Medicaid programs.

The Sanctioned List contains the name, address and license number of persons, providers or entities sanctioned by the agency. In some circumstances, the agency has discretion to, and in others must, impose a sanction against a person, provider or entity, for failure to comply with Medicaid laws, rules or policies. Sanctions may vary significantly, depending on the nature and seriousness of the violation. By way of example, sanctions may include, but are not limited to, corrective actions such as education or selfaudits, monetary penalties , suspensions and terminations.

The Terminated List contains the name, address and license number of persons, providers or entities which are terminated for cause from participation in the Medicaid program. Such terminations are imposed by the agency under its statutory and/or regulatory authority, and are commonly referred to, and known as, for cause or with cause terminations. .

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Where Can I Find A Doctor That Accepts Medicare And Medicaid

To find a doctor that accepts Medicare payments, you may want to visit the Centers for Medicare and Medicaid Services’ Physician Compare. You can search by entering a health care professionals last name or group practice name, a medical specialty, a medical condition, a body part, or an organ system. This tool will provide you with a list of professionals or group practices in the specialty and geographic area you specify, along with detailed profiles, maps and driving directions.

Please note that Physician Compare only lists professionals that accept Medicare. Although some may also accept Medicaid, it does not have information about which professionals do accept Medicaid.

Medicaid programs vary by state and each state Medicaid agency maintains their own list of professionals that accept Medicaid. For further assistance, please contact your health plan or state Medicaid agency. For more information about Medicaid, visit the Medicaid & CHIP page on Healthcare.gov.

If you have trouble accessing the Physician Compare website, please call 1-800-MEDICARE and a representative will be able to run the search for you. They can also send you a print version of the search results.

There are other directories on MedlinePlus that will help you find health professionals, services, and facilities, some of which may serve Medicare or Medicaid payments.

Member Forms & Resources

Accepted Insurance Plans

Notice of Privacy Practices

We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it.

You can download a copy of our Notice of Privacy Practices below.

  • PDF 126.63KB – Last Updated: 11/12/2020

Health Plan Performance Measures

View the Agency for Health Care Administrations website where you can view our health plans performance measure results and compare with those of other health plans.

  • PDF 1.36MB – Last Updated: 04/06/2021

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For A Lifetime Of Wellness

Being truly known is one of the greatest joys in life having someone who sees you for who you are, knows whats going on in your life, and cares for your health and wellbeing. This is the definition of a primary care doctor. Developing an ongoing relationship with your primary care physician and making it a priority to tend to preventive care and steady care of chronic conditions, is the best thing you can do for your long-term health. The primary care providers at AdventHealth are here for your health. Let us help you start down a path leading to a lifetime of wellness in body, mind, and spirit.

Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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A Health Care Plan That Is Easy To Use And Understand

AmeriHealth Caritas Florida operates as a Medicaid managed care plan through Florida’s Statewide Medicaid Managed Care program. AmeriHealth Caritas Florida is part of the AmeriHealth Caritas Family of Companies. AmeriHealth Caritas Florida has earned the Commendable Health Plan Accreditation status from the National Committee for Quality Assurance for 2019 2020.

Florida Attorney Generals Medicaid Fraud Control Unit

Video: Central Florida medical provider accused of defrauding thousands from Medicaid

The Florida Attorney Generals Medicaid Fraud Control Unit investigates and prosecutes providers that intentionally defraud the states Medicaid program through fraudulent billing practices. The MFCU investigates a wide range of misconduct originating primarily from fraudulent billing schemes. The most common schemes involve doctors, dentists, clinics and other health care providers billing for services never performed, over billing for services provided, or billing for tests, services and products that are medically unnecessary. From January 2019 to the present, the Florida MFCU has obtained more than $70 million in settlements and judgments.

AHCAs mission:

Our mission is Better Health Care for All Floridians. As champions of that mission, we are responsible for the administration of the Florida Medicaid program, licensure and regulation of Floridas health facilities and for providing information to Floridians about the quality of care they receive.

The AHCA is divided into various units and subunits that work collaboratively to fulfill the AHCA program integrity responsibilities. These include:

  • Independent examination and evaluation of Agency programs, activities, and resources.
  • Internal investigations of alleged violations of Agency policies, procedures, rules or laws.
  • Investigation of suspected fraud and/or abuse of the states Medicaid program.
  • routine and complaint inspections and plans and construction reviews for certain facilities
  • Recovery of overpayments
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    Unitedhealthcare Connected Benefit Disclaimer

    This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

    You can get this document for free in other formats, such as large print, braille, or audio. Call , TTY 711, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

    You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

    Language Line is available for all in-network providers.

    Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al , TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

    Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

    Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

    Florida Medicaid Contract Provisions Related To Exclusion And Screening

    The Florida template Medicaid contract with managed care organizations includes the several provisions related to exclusions and screening. The 2020 Florida Template Medicaid Health Plan Contract specifically requires contracted managed care organizations to check monthly the AHCA listing of suspended and terminated providers to ensure that they do not include any non-Medicaid eligible providers in its network.

    Attachment II Core Provisions

    Section X. Administration and Management

    F. Fraud and Abuse Prevention

    4. Compliance Plan and Anti-Fraud Plan

    d. At a minimum, the Managed Care Plans compliance plan, anti-fraud plan, and fraud and abuse procedures shall comply with s. 409.91212, F.S., and with the following:

    Not knowingly employ or contract with individuals or entities debarred or excluded from participation in any federal health care program under ss. 1128 and 1128A of the Social Security Act, nor with an individual or entity who is an affiliate, as defined in the Federal Acquisition Regulation at 48 CFR 2.101, of a person described in 42 CFR 438.610 or subcontractors on the discriminatory vendor list maintained by the Department of Management Services in accordance with s. 287.134, F.S. and 42 CFR 431.55 42 CFR 438.610 ss. 1128 and 1903 of the Social Security Act 42 CFR 1001.1901 42 CFR 1002.3 State Medicaid Director Letters 6/12/08 and 1/16/09 Executive Order No. 12549)

    Recommended Reading: How Can I Check If I Still Have Medicaid

    Statutory Authority For Exclusion

    Floridas authority to suspend and terminate providers from participation in state Medicaid programs is found in Florida Statutes Chapter 409 Section 913. Under the terms of this statute, the AHCA is required to oversee the activities of Florida Medicaid recipients, and providers and their representatives, to ensure that fraudulent and abusive behavior and neglect of recipients occur to the minimum extent possible, and to recover overpayments and impose sanctions as appropriate.

    Sections 409. 913 and specifically address provider suspension and termination by the AHCA:

    409.913The agency shall terminate participation of a Medicaid provider in the Medicaid program and may seek civil remedies or impose other administrative sanctions against a Medicaid provider, if the provider or any principal, officer, director, agent, managing employee, or affiliated person of the provider, or any partner or shareholder having an ownership interest in the provider equal to 5 percent or greater, has been convicted of a criminal offense under federal law or the law of any state relating to the practice of the providers profession, or a criminal offense listed under s. 408.809, s. 409.907, or s. 435.04. If the agency effects a termination under this subsection, the agency shall take final agency action.

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