Benefit: Hospital Services: Inpatient

Definition: An inpatient is someone who is "admitted" to the hospital and stays overnight or for an indeterminate time, usually several days or weeks. Florida covers inpatient services provided under the direction of a licensed physician or dentist. Inpatient hospital services includes:

• room and board,
• medical supplies,
• diagnostic and therapeutic services,
• use of hospital facilities,
• medications and biological tests,
• nursing care, and
• all supplies and equipment necessary to provide the appropriate care and treatment of patients.

Limits:  Medicaid coverage for inpatient hospital care for adults age 21 and older is limited to 45 days per state fiscal year (July 1 through June 30). There is no limit on the number of days for recipients 20 years old or younger.

Admissions for hospital inpatient services must be prior authorized. However, certain categories of recipients and circumstances are exempt from the prior authorization requirement. For example, some recipient exemptions are as follows:

• those enrolled in a HMO or PSN;
• Dual eligibles for both Medicare and Medicaid; and
• those enrolled in the Children’s Medical Service (CMS) Network.

Exceptions:Medicaid will reimburse inpatient hospital services to a non-Medicaid-participating hospital in an emergency, for the duration of the emergency.  Medicaid will not reimburse a recipient in the Presumptively Eligible Pregnant Women (PEPW) program. They are not eligible for services associated with labor, delivery, postpartum, and inpatient hospitalization.

Co-pays: $3.00 per admission unless the recipient is exempt.

Reform items that can vary: Co-pays.