Frequently Asked Questions
- What are Medicaid Reform and Choice Counseling?
Florida Medicaid Reform began on July 1, 2006, as a pilot project in Broward and Duval counties. One year later on July 1, 2007, the three counties of Baker, Clay and Nassau were added to counties served by Medicaid Reform. Medicaid beneficiaries in those counties who are eligible for reform receive their health services through a health plan.
Choice Counseling is a free service provided by trained Choice Counselors for Medicaid beneficiaries who need to enroll in a health plan. Beneficiaries may receive counseling by calling the Choice Counseling Call Center or in one-on-one meetings.
- Do I have to enroll in Medicaid Reform?
Not every Medicaid beneficiary living in a Reform county has to enroll in a health plan. If you are required to participate in Florida Medicaid Reform, you will receive a bright green packet from Florida Medicaid telling you to choose a plan. You will have 30 days to pick a plan and if you do not choose, you will be assigned to a plan. You may contact a Choice Counselor who will go over the different plans with you. Information on how to contact a Choice Counselor will be included in your packet.
- How will I know which health plan to choose?
A Choice Counselor, trained on the different Florida Medicaid Reform plans, will assist you in making this important choice. You might want to think about these things when deciding on a plan:
Which Florida Medicaid services are most important to you and your family's health needs?
Which Florida Medicaid providers are most important to you?
Will you want to keep your same doctors?
Are there other services you need that Florida Medicaid does not cover, but a Reform plan does cover?
Is prescription medication coverage an important need for you?
Are there hospitals or clinics you will want to use?
Deciding which services are the most important to you will help you make an informed health plan choice. Remember, the choice is yours.
- Will I have a co-payment, co-insurance or deductible with Reform health plans?
There are no deductibles in Florida Medicaid Reform health plans. A health plan may require a small co-payment or co-insurance for some services. Children and pregnant women will not have co-payments or co-insurance.
- Will I lose my primary doctor if I enroll in a Medicaid Reform health plan? What about my specialist?
Most of the primary care doctors and specialists are enrolled with one or more of the Florida Medicaid Reform health plans. You may contact a Choice Counselor who can tell you which plans your doctors work with.
- Will my child lose his/her present services, such as therapies?
No, all medically necessary services for children are covered under Florida Medicaid Reform, such as physical, occupational, speech, and respiratory therapy services. Florida Medicaid Reform plans can also offer additional services not covered by Florida Medicaid.
- Do the Reform health plans provide the same services that I receive
today, and do the Reform health plans limit the number of visits, specialists,
Florida Medicaid Reform health plans will continue to provide medically necessary services for children and pregnant women. For everyone else the services available today will continue to be available, but the plans may have different levels of coverage.
- I am enrolled in a home and community based Waiver. How does Reform affect
You will receive these services as you do today.
- Does the Reform health plan pay for transportation to appointments?
Yes, transportation is a service covered under Florida Medicaid Reform.
- Will the Reform health plan pay for durable medical equipment for my
child (example: braces, walkers, wheelchairs)?
Yes, Florida Medicaid Reform health plans will provide medically necessary durable medical equipment.
- Does everyone in my family have to enroll in the same plan?
No, each family member can enroll in a different plan.
- Will I be able to change my health plan during my no-change (lock-in) period?
There are many reasons that a person is allowed to change health plans in a no-change period. A person may request a plan change if he/she meets one of the Good Cause reasons on the list below:
The primary care provider no longer takes the plan that the beneficiary is enrolled in,
The beneficiary is enrolled in a plan that exceeds the plan’s age limit (or other criteria),
The beneficiary was misled by the plan representative,
The plan is not providing effective care,
The beneficiary lives in a county in which the plan does not participate, or the system indicates that the materials sent by Choice Counseling were not received and returned to us,
The plan does not allow the beneficiary to make decisions regarding treatment,
The plan does not provide translation services for the beneficiary to communicate with the provider, or the providers are more than XX miles away from the beneficiary,
The beneficiary is not able to see a specific provider that he/she has an established relationship with,
The plan change was requested and an error occurred that prevented it from processing,
The plan no longer exists in the beneficiary’s county,
The beneficiary missed all or part of their Open Enrollment period due to temporary loss of eligibility,
The plan does not provide a specific service due to moral or religious reasons,
The beneficiary needs related services that are not provided by the current plan,
The plan is sanctioned by the Agency for Healthcare Administration,
It is necessary for the beneficiary to change to a specialty plan,
The plan reduced the amount of services that a beneficiary can receive (only for the 10 flexible services)
- How can I get more information about Florida Medicaid Reform?
Call a Choice Counselor at 1-866-454-3959, TDD 1-866-467-4970, Monday through Thursday 8 a.m. to 8 p.m.; Friday from 8 a.m. to 7 p.m.; Saturday 9 a.m. to 1 p.m.