Ways To Apply For Chip:
- Fill out an application through the Health Insurance Marketplace®. If it looks like anyone in your household qualifies for Medicaid or CHIP, well send your information to your state agency. Theyll contact you about enrollment. When you submit your Marketplace application, youll also find out if you qualify for an individual insurance plan with savings based on your income instead. Create an account or log in to an existing account to get started.
FYI: Apply any time
You can apply for and enroll in Medicaid or CHIP any time of year. Theres no limited enrollment period for either Medicaid or CHIP. If you qualify, your coverage can start immediately.
Already Enrolled In Florida Medicaid
If you want to switch from your current Medicaid plan and enroll in Humana Healthy Horizons in Florida, you can:
- Text ENROLL to FLSMMC
- You will need the Medicaid ID number for each member and the account PIN number.
To pick a new plan, you will need each members birth year and Medicaid ID or Gold Card number.
What Information Does The Medicaid Application Require
Page 1 of actual Medicaid application actually begins on the third page of the 18 page application packet. It starts by asking which program you are applying for. While my elder law attorney office primarily assists clients with Medicaid Waiver / Home & Community Based Services and Nursing Home Care Medicaid benefits, the application can also be used for Food Assistance, Cash Assistance, Relative Caregiver Assistance, Medical, Hospice, and OSS / Optional State Supplementation programs.
The application will also ask for basic contact information, whether it is difficult to come into the office for an interview .
The Medicaid application will have you acknowledge that DCF will verify statements made and may consult with other state/federal agencies for that purpose. You provide DCF permission to consult with prior employers,review any pertinent medical records, etc.. You also agree, under penalty of perjury, to provide accurate information to the best of your knowledge.
Page 2 starts with information if the Medicaid applicant is seeking expedited food assistance. Below is Section A, which involves entering all household member information. For nursing home or ALF residents, you only list yourself, your spouse and dependents .
Page 3, Section B, lists children living in the Medicaid applicantâs home. Section C involves listing absent parents .
Page 5, Section E â Assets. Must list all assets here, account number or insurance ID, and the assetâs value.
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What Information Do I Need
- Name, date of birth, Social Security Number, and home address of each person with ownership or control interest in the provider.
- Name, Federal Employer Identification Number, and applicable addresses for each entity with ownership or control interest in the provider
- Internal Revenue Service document showing the provider’s name and tax identification number
- Professional or facility license number, as appropriate.
- National Provider Identifier from the National Plan and Provider Enumeration System , as appropriate.
- Documentation of any adverse actions involving:
- Criminal History,
- Disciplinary action against any license,
- Denial, termination, exclusion, suspended payments, or unpaid fines from Medicare or Medicaid in this or any state.
How Do I Enroll In Medicaid In Florida
Review Floridas eligibility criteria, and if you believe you are eligible to enroll in Medicaid you have several options:
- Enroll at Healthcare.gov .
- Apply online at ACCESS Florida, or fill out a paper form. Use this application for low-income children, pregnant women, families, and aged or disabled individuals who are not currently receiving Supplemental Security Income .
- Use this application to apply for food or cash assistance in addition to Medicaid. You should also use this form if you currently receive SSI or if you are applying for home-based and community services, hospice care, or nursing home care.
- Submit a paper application submitted by mail, fax or in person to a local service center.
For help with the application process, call 1-866-762-2237.
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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.
Additional Smmc Ltc Information:
For additional SMMC LTC information, including a program overview and summary, please visit AHCAs website at .
For information regarding the LTC plans available in each region and how to choose an LTC plan, please visit the Choice Counseling website at www.flmedicaidmanagedcare.com.
For more information regarding the SMMC LTC waitlist, please contact your local Aging and Disability Resource Center. Click here for the direct contact information of the ADRC in your region. You can also call the statewide Elder Helpline at 1-800-96-ELDER for immediate assistance.
For assistance in addressing a complaint with your LTC plan, please visit AHCAs website at and click on the Report a Complaint button.
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Phone Number To Medicaid Options Odjfs Online
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No Aca Medicaid Eligibility Expansion In Florida
Florida is one of 12 states that has not expanded Medicaid eligibility as allowed under Affordable Care Act . The ACA doesnt provide subsidies for people with income below the poverty level, because the law called for them to have Medicaid instead. But in states that have refused Medicaid expansion people who arent eligible for Medicaid and whose income is too low for exchange subsidies are in whats called the coverage gap.
Floridas eligibility standards are:
- Children up to 1 year old: 206% of the federal poverty level
- Children ages 1-5: 140% of FPL
- Children ages 6-18: 133% of FPL
- Pregnant women: 191% of FPL
- Adults with dependent children: 27% of FPL
People who qualify for Supplemental Security Income automatically qualify for Medicaid in Florida. See more information in the SSI-Related Programs Financial Eligibility Standards.
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History Of Floridas Medicaid Program
Florida was one of the later states to implement a Medicaid, not adopting the program until January of 1970 .
Florida Medicaid spending grew 13.5% on average every year between 1980 and 2004. In an effort to slow that trend, Florida applied for and received approval for an 1115 waiver for its Medicaid Reform pilot. The pilot implemented managed care in two counties in 2006 and added three more counties in 2007 the waiver was extended several times.
In 2013, the federal government approved an amendment for statewide expansion of managed care the amendment also renamed Medicaid Reform as Managed Medical Assistance . Ninety percent of all Florida Medicaid beneficiaries are now enrolled in managed care plans, like health maintenance organizations . The state hopes to improve quality through better coordination of care and save money through smaller networks of providers.
Part of the reason Medicaid enrollment has grown is the extensive outreach on the part of ACA navigators some residents were already eligible for Medicaid or CHIP prior to 2014 , but werent aware of their eligibility until enrollment outreach efforts under the ACA. But since Florida hasnt expanded Medicaid, the newly insured population is covered according to the normal state/federal split.
Floridas decision not to expand Medicaid leaves nearly 400,000 people in the state in the coverage gap ineligible for Medicaid and also ineligible for tax subsidies to help them afford private health insurance .
Why Choose Humana Healthy Horizons In Florida
We designed Humana Healthy Horizons in Florida to provide you with the care and support you need so you have more time to focus on what you love.
Now more than ever, your health and healthcare coverage are important. Humana Healthy Horizons in Florida makes available to Florida Medicaid enrollees access to the high-quality healthcare coverage you want and extras you need.
Humana is proud of our strong, 20-year relationship with Florida Medicaid. Were focused on helping you make the most of your plan.
Here are some things to know about enrolling in a Florida Medicaid plan:
- All Medicaid plans have $0 copays
- All Medicaid plans have the same basic benefits
- All Medicaid plans have the same drug coverage
- Some plans, like Humana Healthy Horizons in Florida, may have extra services or perks.
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Florida Has Not Accepted Federal Medicaid Expansion
- 4,956,941 Number of Floridians covered by Medicaid/CHIP as of September 2021
- 1,378,000 Number of additional Florida residents who would be covered if the state accepted expansion
- 415,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
- $6.6 billion Federal money Florida is leaving on the table in 2022 by not expanding Medicaid
See If Your Children Qualify And Apply For Chip
Each state program has its own rules about who qualifies for CHIP. You can apply right now, any time of year, and find out if you qualify. If you apply for Medicaid coverage to your state agency, youll also find out if your children qualify for CHIP. If they qualify, you won’t have to buy an insurance plan to cover them.
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How Does Medicaid Provide Financial Help To Medicare Beneficiaries In Florida
Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare including long-term care.
Our guide to financial assistance for Medicare enrollees in Florida includes overviews of these programs, including Medicaid nursing home benefits, Extra Help, and eligibility guidelines for assistance.
Do You Have Questions
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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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!
Medicaid Lawyer Final Thoughts On The Medicaid Application
While you can fill out this application yourself, issues can arise when information is entered incorrectly or insufficiently. Not fully understanding what DCF is requesting can result in unnecessary delays and denials that can cost the Medicaid applicant significant sums of money â especially when nursing homes are involved.
But the choice is yours. Certainly, for those who are not currently eligible for Medicaid, but would like to be, we charge for the legal strategies necessary for Medicaid qualification. We would then charge an additional amount if the client wanted us to apply on their behalf . Clients come to us for one, the other, or both.
For those who wish to try handling the Florida long term care medicaid application themselves, here is an article that discussed some Common Mistakes Found on Medicaid Applications.
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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.
What Is In The Access Florida Medicaid Application
First â there is no requirement that you hire a Medicaid attorney to apply for Medicaid benefits. The Medicaid application can be filled out online , a , including Medicaid application and Medicaid-application instructions, can also be accessed. Medicaid applicants can call 1-866-762-2237 for more information as well: this number provides general program information, health care provider options , medicaid EDT information , etcâ¦
Prior to filling out the Medicaid application, many individuals who do not already qualify, will seek the advice of a Medicaid lawyer for help with the Medicaid application. It is important to consult with a Medicaid lawyer prior to applying because if you apply prior to being eligible, you will undoubtedly be denied.
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Independent Consumer Support Program:
The Independent Consumer Support Program , is a coordinated effort by the Florida Department of Elder Affairs Bureau of Long-Term Care & Support , working in collaboration with the statewide Long-Term Care Ombudsman Program , the local Aging and Disability Resource Centers , and AHCA. Floridas ICSP operates using the staff of LTCS, local ADRCs, and the LTCOP to ensure that SMMC LTC consumers have multiple access points for information, complaints, grievances, appeals, or questions. Additionally, this three-pronged approach allows consumers a no wrong door access to the ICSP complaint resolution process, in addition to targeting the specific group who can best address a specific complaint, grievance, or question.
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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How To Apply / Learn More
When the applicant senior is not in a nursing home, the application process starts with a call to the Florida seniors local Area Agency on Aging. One can also call the Elder Helpline. Find the number by county here. Callers should request a screening for home and community based services. The representative schedules a time for the phone screening with the primary caregiver or closest family member, usually one to two weeks out. The screening interview typically lasts 30 to 40 minutes. The interview covers basic demographic information for the applicant as well as his/her income and assets. The interview mostly asks about the elders needs for care, including his/her ability to perform Activities of Daily Living.
Following the interview, the elder receives a prioritization decision. This letter indicates whether services can begin immediately or whether the senior needs to be waitlisted. If the senior is prioritized for home or community supports to start immediately, he/she must apply to the Department of Children and Family Services through the ACCESS System for their formal Medicaid approval.
To learn more about SMMC LTC, .
Like Floridas HCBS Medicaid Waivers that served this population before the creation of this program, SMMC LTC has a limit on the number of persons who can receive assistance at the same time. Waiting lists for some services likely exist in areas throughout the state.
Apply For Medicaid In Florida
Online at ACCESS Florida, or submit a paper application by mail, fax or in person to a local service center. For help with the application process, call 866-762-2237.
Eligibility: Children up to 1 year old with family income up to 206% of FPL children 1-5 with family income up to 140% of FPL children 6-18 with family income up to 133% of FPL pregnant women with family income up to 191% of FPL young adults 19-20 with family income up to 30% of FPL adults with dependents with family income up to 30% of FPL.People who qualify for Supplemental Security Income automatically qualify for Medicaid. For information: SSI-Related Programs Financial Eligibility Standards
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