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General Information

About Medicaid Reform

Medicaid Reform is Florida's new health care program for Medicaid beneficiaries that will increase choice and offer more services for you and your family.

Medicaid Reform began in Broward and Duval counties in July, 2006, and expanded into Baker, Clay and Nassau counties in July, 2007. Under Medicaid Reform, health care services are provided by health plans. Health plans will offer services that are tailored to specific medical group needs and provide services currently not offered by Medicaid.

Beneficiaries who participate in "Healthy Behaviors" will earn "credits" in their personal Enhanced Benefits Reward$ Program account. These credits can be used to purchase items such as over-the-counter drugs, vitamins and other health-related products. These items can be purchased at any Medicaid pharmacy. If you leave Florida Medicaid coverage, you may still use the remaining credits in your enhanced benefit rewards account to pay for health-related supplies.

Picking a health plan is a personal decision. Florida Medicaid Reform beneficiaries will have the opportunity to talk with a Choice Counselor. The Choice Counselor does not work for any of the health plans. The Choice Counselor will provide you with detailed information about the various health plans available to best meet your needs.

As with Florida Medicaid today, each Florida Medicaid Reform health plan offers:

  • All of the basic Florida Medicaid services;
  • A network of specialists, hospitals, clinics and drugstores you can use; and
  • A choice of doctors to be your Primary Care Provider (PCP)

Additionally, Medicaid Reform will:

  • Give you more health plans to pick from
  • Let you pick the health plan that best meets your health care needs
  • Reward you for healthy living
  • Make services not offered today by Medicaid available to you

Participation

If you live in Baker, Broward, Clay, Duval or Nassau counties and are currently enrolled in the Florida Medicaid Program, you may be required to enroll in the new Florida Medicaid Reform Program. You will have a choice of either a Provider Service Network (PSN) or a Health Maintenance Organization (HMO).

The Florida Medicaid Program will send you a letter informing you when it's time for you to pick a plan. Please check your mail, as you will have 30 days to pick a plan.

You do not have to participate if you are a:

  • Foster Care Child/Adoption Subsidy Child (can voluntarily enroll)
  • Individual with developmental disabilities (can voluntarily enroll)
  • Individual with Medicare and Medicaid (can voluntarily enroll)
  • Individual residing in an institution including nursing facilities and sub-acute inpatient psychiatric facilities for children under the age of 21
  • Intermediate Care Facilities/Developmentally Disabled Individual (ICF-DD)
  • Family Planning Waiver beneficiary
  • Medicaid beneficiary who has other creditable health-care coverage
  • Medically Needy beneficiary
  • Individual enrolled in hospice
  • Individual only eligible for Florida Medicaid because you are pregnant

If you are unsure of which population you are in and what your enrollment requirements will be, call a free Choice Counselor at 1-866-454-3959 or 1-866-467-4970 for TDD users.


Benefit Information

Please visit the Benefits section of this website to view detailed information about each plan.


When must you enroll in Medicaid Reform?

If you are a new Medicaid beneficiary required to enroll in a Medicaid Reform health plan, you will receive in the mail a green envelope that contains an enrollment packet and information about Reform health plans in your area (or go to step 1 at this website to view plans). You will have 30 days to select a Reform health plan and enroll in an employer's health insurance plan. A Reform health plan will be chosen for you by the State if you do not pick a health plan within 30 days.

If you are a current Medicaid beneficiary in a mandatory Medicaid Reform beneficiary group, you will receive in the mail a green envelope that contains an enrollment packet and information about Reform health plans in your area (or go to step 1 at this website to view health plans). You must transition to a Reform health plan within 30 days from the date of the notification letter you receive in the green envelope. If you do not pick a health plan, a plan will be selected for you by the State.

Once you are enrolled in a Reform health plan, you will have 90 calendar days to change plans for any reason. After the 90 calendar days trial period, you will be locked-in for the remainder of the 12-month period, and no further changes may be made until the next open enrollment period, except for cause.

If you do not make a choice and enroll within 30 days, the State will choose a health plan for you, based on the following:

  • If you are currently with a managed care organization that now offers a Reform health plan, you will be assigned to the most appropriate Reform health plan offered by that organization.

  • If you are currently with a managed care organization that does not offer a Reform plan, or if you are with MediPass, you will be assigned a Reform health plan in accordance with assignment criteria designed to meet your needs.

PICK THE BEST PLAN FOR YOU AND YOUR FAMILY AND ENROLL

Get Started by Going to Pick your Plan (Step 1)

To get help, call the toll-free Helpline: 1-866-454-3959; TDD 1-866-467-4970. If you need Medicaid information in large print, audiotape or Braille, call the Helpline.

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