Website Glossary

Beneficiary - A person who is eligible for Medicaid.

Cause - Also known as "For Cause" or "Good Cause". These are reasons to change health plans during the lock-in period. (see definition of lock-in)

Choice Counselor - Choice Counseling is a free service to help Medicaid beneficaries pick the health plan that is best for them. Picking a plan can be hard. For someone with special health care needs or circumstances the choice can be even more difficult. A Choice Counselor is the person that helps the beneficiary understand their health plan choices and enrolls them into a Medicaid health plan.

Co-payment (Co-pay) - an amount paid by the beneficiary for each visit or treatment. Not all visits or treatments require a co-pay. Children and pregnant women are not subject to co-pays for services that are medically necessary.

Enhanced Benefits Account - The account where credits for completing a Healthy Behavior (see definition) will be deposited and where credits will be removed when beneficiaries use the credits to purchase over the counter health-related supplies.

Healthy Behaviors - Are behaviors that earn credits that are put into a beneficiaries Enhanced Benefit Account (see definition). Examples of behaviors are:

Childhood exams
Mammogram / pap smear
Colorectal screening
Adult exams
Disease management participation
Alcohol / drug treatment program participation
Smoking cessation program participation
Weight loss program participation
Exercise program participation

Health Maintenance Organization (HMO) - HMOs are corporations, licensed under Chapter 627 F.S., that contract with a network of health care providers, such as physicians, hospitals, and laboratories to provide health care services.

Lock-In - The period of time that beneficiares can not change health plans.

Open Enrollment - The 60 day period that beneficaries can change health plans without cause. After open enrollment recipieints will not be able to change plans for the next year unless they have cause (see definition).

Opt-Out and Employer Sponsored Insurance (ESI) - is a new program under Medicaid Reform that will allow a beneficiary to use Medicaid dollars to purchase insurance offered through their job.

Primary Care Provider (PCP) - Is usually a doctor that monitors your health, treats minor health problems, coordinates your health care, and refers you to a specialist if needed.

Provider Service Networks (PSNs) - Health care delivery systems owned and operated by hospitals or physician groups. PSNs have a network of providers and facilities, which provide health care to enrolled beneficiaries.

90 Calendar Day Change Period - After being enrolled in a health plan, all beneficiaries will have 90 calendar days to "try out" their plan and change to a new plan if they wish.

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.