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A Snapshot of the Florida Statewide Managed Care Program How do I enroll in the Long-Term Care program?  If you meet LTC Program eligibility requirements and live  The Statewide Medicaid Managed Care (SMMC) Program in a nursing facility, you will be automatically enrolled in has two program components: the LTC Program, and you will receive information about 1. Managed Medical Assistance (MMA) and Long-Term available LTC plans from the choice counselor by mail. Care (LTC)  Because space is limited in the LTC program for 2. Dental individuals who want to receive services at home, if you  A person eligible for Florida Medicaid can be enrolled in are 18 years of age or older and live at home, in an both the MMA and LTC program or just the MMA program. assisted living facility, or in an adult family care home, you  Everyone receiving dental services from Florida Medicaid must be screened and placed on the LTC Program waitlist must be enrolled in the Dental program. before being enrolled in the program. Contact your local Aging and Disability Resource Center (ADRC) to be placed on the waitlist. A list of the ADRC is available on the Florida Department of Elder Affairs’ website at http://elderaffairs.state.fl.us/doea/arc.php.  The ADRC will complete a short screening over the phone, which results in a score that is used to rank you on the waitlist. When enrollment is available, the ADRC will contact you to begin the enrollment process.

What region am I in? Region Counties 1 Escambia, Okaloosa, Santa Rosa, and Walton Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, 2 Liberty, Madison, Taylor, Wakulla, and Washington Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, 3 Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union The SMMC program has five types of plans: 4 Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia - Managed Medical Assistance: Provides MMA 5 Pasco and Pinellas services to eligible recipients. This plan cannot 6 Hardee, Highlands, Hillsborough, Manatee, and Polk provide services to recipients who are eligible for 7 Brevard, Orange, Osceola, and Seminole Long-term Care services. 8 Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota - Long-Term Care Plus: Provides MMA services and 9 Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie LTC services to recipients enrolled in the LTC 10 Broward program. Cannot provide services to recipients who 11 Miami-Dade and Monroe are only eligible for MMA services. - Comprehensive: Provides MMA services and LTC When will I be notified and be required to enroll? services to eligible recipients.  Once determined to be eligible for Medicaid, recipients or - Specialty: Provides MMA services to eligible their designee will receive a letter within 5 days of their recipients who are defined as a specialty population. notification of eligibility. - Dental: Provides dental services to all recipients in  Recipients must choose a plan by the date listed in the managed care and all and fully eligible fee-for-service letter that is sent to all recipients. individuals.  If no plan selection is made, the recipient will be enrolled in the health plan listed in the letter. Who is required to enroll in the SMMC program?  Recipients have a 120-day change period, in which they  Most Medicaid recipients must enroll in the MMA program can change their plan, which begins on the effective date and in the Dental program. Individuals wishing to receive of their enrollment in the plan. Medicaid covered Long-Term Care services must enroll in the LTC program. These are both known as “mandatory.” How do I choose a plan?  Certain individuals, known as “voluntary”, can choose  Choice counselors are available to assist recipients in whether to enroll in MMA or LTC, and some, known as selecting a plan that best meets their needs. This “excluded”, are not allowed to enroll in the MMA, LTC or assistance will be provided by phone by calling Dental programs. 1-877-711-3662. In-person visits are also available by Who Must, Who Can, and Who Cannot Participate in MMA, Dental MMA LTC LTC and Dental Programs request for recipients with special needs. Emergency Medicaid for NonCitizen Enrollees Excluded Excluded Excluded  Recipients can also enroll online at: Family Planning Waiver Enrollees Excluded Excluded Excluded www.flmedicaidmanagedcare.com. Breast and Cervical Cancer Program Enrollees Excluded Excluded Excluded Program of All-Inclusive Care for the Elderly Enrollees Excluded M (unless otherwise E or V) Excluded  The Aging and Disability Resource Center (ADRC) is also Medically Needy Program Enrollees M Excluded Excluded available to assist recipients with any questions you Refugee Assistance Enrollees M V Excluded LTC Presumptively Eligible Pregnant Women Excluded Excluded Excluded may have. Partial Dual Eligibles Excluded Excluded Excluded M (Must Meet Recipients who have other health coverage (excluding ) M V LTC Criteria) Prescribed Pediatric Extended Care Center patients M V N/A Recipients who have elected to enroll in a home and community M M (unless otherwise E or V) Excluded based waiver other than LTC* iBudget Enrollees and Waitlist Population* M V Excluded Residents of a developmental disability center M V Excluded Residents in a group home facility licensed under chapter 393. M V N/A Residents of a treatment facility as defined in s. 394.455(47) M M (unless otherwise E or V) Excluded Residents of a DJJ residential commitment facilitie Excluded Excluded Excluded Residents of a State Mental Excluded Excluded Excluded *Waiver enrollees (not on a waitlist) are voluntary for LTC, but they must have a nursing facility level of care and disenroll from the other waiver in order to enroll in the LTC program. 1

A Snapshot of the Florida Statewide Medicaid Managed Care Program LTC program? What Health & Dental Plans are available in my region? LTC Minimum Covered Services 1 2 3 4 5 6 7 8 9 10 11 Adult companion care Intermittent and skilled nursing (Comp) X X X CCP* (MMA) X Adult day Medical equipment and supplies FCC** (LTC +) X X X X X X X X X X X Assisted living Medication administration (Comp) X X X X X X X X X X X Assistive care services Medication management Molina (Comp) X X Prestige (MMA) X X Attendant care Nursing facility Simply (Comp) X X X X X Behavioral management Nutritional assessment/ risk reduction Simply (MMA) X X X Care coordination/ Case Staywell (Comp) X X X X X X X X X X Personal care Sunshine (Comp) X X X X X X X X X X X management United (Comp) X X X X Caregiver training Personal emergency response system Vivida (MMA) X Home accessibility adaptation Respite care DentaQuest (Dental) X X X X X X X X X X X Therapies: occupational, physical, Liberty (Dental) X X X X X X X X X X X Home-delivered meals respiratory and speech MCNA Dental X X X X X X X X X X X (Dental) Homemaker Transportation, Non-emergency *CCP = Community Care Plan **Florida Community Care Hospice What are MMA Specialty plans?  Specialty plans will serve populations with a distinct What Medicaid covered services are provided under the diagnosis or chronic condition. These plans are tailored to Dental program? meet the specific needs of the specialty population. LTC Dental Minimum Covered Services recipients cannot enroll in specialty plans. Ambulatory Surgical Center or Orthodontics  Information on each specialty plan is available through the Hospital-based Dental Services choice counseling website: Dental Exams Periodontics Dental Screenings Prosthodontics (dentures) www.flmedicaidmanagedcare.com Dental X-rays Root Canals Extractions Sealants What Specialty plans are available in my region? Fillings and Crowns Sedation 1 2 3 4 5 6 7 8 9 10 11 Fluoride Space Maintainers Oral Health Instructions Teeth Cleanings Children’s Medical Services Plan (Children X X X X X X X X X X X What benefits not otherwise covered by Medicaid are with Chronic Conditions) Clear Health Alliance available from plans? X X X X X X X X X X X (HIV/AIDS)  Health and dental plans cover expanded benefits which Magellan Complete Care X X X are offered in addition to the standard benefit package (Serious Mental Illness) Staywell offered by Medicaid. X X X X X X X X X X X (Serious Mental Illness)  A full list of expanded benefits, by plan, can be found on Sunshine Health X X X X X X X X X X X the Agency’s website: (Child Welfare) http://ahca.myflorida.com/Medicaid/statewide_mc/pdf/mm What Medicaid covered services are provided under the a/EB_Chart_Revised_101618.pdf or by visiting MMA program? www.ahca.myflorida.com/smmc. Once on the website, click on the Outreach and Presentations link in the SMMC MMA Minimum Covered Services Program Changes box and look for the Expanded Benefits Advanced registered nurse practitioner Hospital Inpatient & Outpatient services Services by Plan Chart document.

Ambulatory surgical treatment center services Laboratory and Imaging Services What if I have a complaint?  Medical supply, equipment, We encourage any individual with a complaint or issue Assistive Care Services prostheses and orthoses relating to the program to contact a Medicaid Birthing center services Medical Foster Care representative by phone at 1-877-254-1055. services Mental health services  You may also complete the online complaint form created by the Agency to provide expedited handling: Early Intervention Services Nursing care http://ahca.myflorida.com/Medicaid/complaints/index.shtml Early periodic screening diagnosis and Nursing facility services for enrollees treatment services for recipients under age not in the LTC program 21 Where can I find more information?  Visit our SMMC website at: Emergency services Optical services and supplies http://ahca.myflorida.com/SMMC Family planning services and supplies (some  Keep up to date by signing up to receive program exception) Optometrist services updates at http://ahca.myflorida.com/SMMC . Click the Healthy Start Services (some exceptions) red “Sign Up for Program Updates” box on the right hand Physical, occupational, respiratory, Hearing services side of the page. and speech therapy Home health agency services Podiatric services Youtube.com/AHCAFlorida services, including Hospice services physician assistant services Facebook.com/AHCAFlorida; Prescription drugs Rural health clinic services Twitter.com/AHCA_FL Transportation to access covered Renal dialysis services services Respiratory equipment and supplies Substance abuse treatment What Medicaid covered services are provided under the 2