Tag: GB-Overview

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How does Florida Medicaid perform on Quality Measures?

Last updated: April 2021

Note: See also managed care data items for this market for more quality outcomes data

Child and Maternal Quality Measure Data

In federal fiscal year (FFY) 2019, Florida reported 21 of 21 frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set.

  • Dental and Oral Health
  • Behavioral Health – Use of Antipsychotics
  • Behavioral Health – Followup after Hospitalization for Mental Illness
  • Acute and Chronic Conditions
  • Prenatal and Postpartum
  • Contraception
  • WellChild Visits- 3 to 6 years old
  • Well Child – Infants
  • Developmental Screenings
  • Access to Primary Care
  • Childhood immunization

Source:

https://www.medicaid.gov/state-overviews/stateprofile.html?state=florida

Adult Quality Measure Data

In federal fiscal year (FFY) 2019, Florida reported 18 of 24 frequently reported health care quality measures in the CMS Medicaid Adult Core Set.

  • Cancer and chlamydia screening
  • BMI assessment
  • Nursing home resident hospital admissions
  • Alcohol and drug abuse treatment
  • Follow-up after hospitalization for mental illness
  • Diabetes screening for persons with SMI
  • Adherence to antipsychotic medications
  • Controlling High Blood Pressure
  • Hemoglobin A1c
  • Acute and chronic conditions
  • Mental and perinatal

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Florida Medicaid Eligibility and Enrollment

Last updated April 2021

How many people are enrolled in Florida Medicaid?

  • FL total Medicaid Enrollment Nov 2020

Latest Detailed Enrollment Data File

ENR_202103Download

Who is eligible for Medicaid in Florida?

Most Medicaid eligibility and all CHIP eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL). The following charts provide a more detailed view of Florida’s MAGI-based eligibility levels, expressed as a percentage of the FPL, for several key groups.

  • Income based eligibility for adults
  • Eligibility criteria- all groups
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Florida: Recent policy initiatives (including waivers)

Last Updated April 2021

Approved Waivers from CMS

Related: What is a Medicaid waiver and why is it important?

Waiver NameTypeExpiration DateSummary
FL Adults with Cystic Fibrosis1915 (c)06/30/2022Provides community support coordination, homemaker, personal care, respite, adult dental services, physical therapy evaluation, physical therapy, prescribed drugs, respiratory therapy evaluation, respiratory therapy, skilled nursing, specialized medical equipment and supplies, chore, counseling, home delivered meals, massage therapy, nutritional supplements, personal emergency response system maintenance and monitoring, personal emergency response unit for medically fragile individuals ages 18 no max age
FL Developmental Disabilities Individual Budgeting1915 (c)03/31/2024Provides life skills development level 3 – adult day training, residential habilitation, respite, support coordination, adult dental services, occupational therapy, physical therapy, respiratory therapy, skilled nursing, specialized medical equipment and supplies, specialized mental health counseling, speech therapy, transportation, behavior analysis services, behavior assistant services, dietitian services, environmental accessibility adaptations, life skills development level 1 – companion, life skills development level 2 – supported employment, personal emergency response system, personal supports, private duty nursing, residential nursing, special medical home care, and supported living coaching for individuals with autism, intellectual disabilities, and developmental disabilities ages 3 – no max age.
Source: CMS

Waiver table incomplete- need to add rest

Recent State Plan Amendments

Related: What is a state plan amendment and why is it important?

SPA #SummaryEffective Date
FL-19-0003Includes the Practitioner reimbursement methodology for services outlined within the State Plan.12/01/2019
FL-20-0007Adjusts reimbursement for Intermediate care facilities for individuals with developmental disabilities (ICF-IID).07/01/2020
FL-20-0005Updates Diagnosis Related Group reimbursement rate methodology for hospital inpatient services.07/01/2020

SPA table incomplete- need to add rest

Source: CMS

Other policy initiatives