Frequently Asked Questions

  1. Applying / Canceling Medicaid and Other Benefits
  2. Billing
  3. Continuity of Care
  4. Definitions
  5. Enrollments / Plan Changes
  6. Health and Dental
  7. ID Cards
  8. KidCare
  9. Medically Needy / Share of Cost
  10. Member Portal
  11. Personal Information Updates
  12. Pregnancy and Newborns
  13. Providers
  14. Special Conditions

Applying / Canceling Medicaid and Other Benefits

  1. I need to apply for Medicaid benefits.

    Call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida, to apply for benefits. If you receive Supplemental Security Income (SSI)benefits, call the Social Security Administration (SSA), at 1-800-772-1213, to apply for Medicaid.

  2. How long does it take to be approved for Medicaid?

    It may take up to 30 days to process your application (longer if you need a disability determination). Call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida for more information.

  3. I completed my Medicaid application and don’t know if I was approved.

    Call the Department of Children and Families (DCF)1-866-762-2237, to find out about your eligibility status.

  4. My Medicaid is ending and I don’t know why.

    If you receive Medicaid through the Department of Children and Families (DCF) call 1-866-762-2237, to find out about your eligibility status. If you receive Medicaid through the Social Security Administration (SSA), you must call SSA at 1-800-772-1213, to find out about your eligibility status.

  5. I need to recertify or renew my Medicaid.

    If you receive Medicaid through the Department of Children and Families (DCF), call 1-866-762-2237. If you receive Medicaid through the Social Security Administration (SSA), call SSA at 1-800-772-1213.

  6. Why do I need to get in touch with the Agency for Persons with Disabilities?

    You will need to get in touch with the Agency for Persons with Disabilities to inquire about applying for available programs and services accessible to Floridians with developmental disabilities such as autism, cerebral palsy, down syndrome, intellectual disabilities, Prader-Will syndrome, and spina bifida. You can reach them at 1-866-273-2273 or visit their website http://apd.myflorida.com/.

  7. I have Medicaid but it is not showing. What do I do?

    Call the Department of Children and Families (DCF) at 1-866-762-2237, or visit the website, www.dcf.state.fl.us/ess, to apply for benefits or check the status of your application. If you receive Supplemental Security Income (SSI) benefits, call the Social Security Administration (SSA) at 1-800-772-1213 to apply for Medicaid or check the status of your application.

  8. I would like to apply for food stamps or cash assistance.

    Call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida, to apply for benefits.

  9. How do I cancel my Medicaid coverage?

    If you receive Medicaid through the Department of Children and Families (DCF), call 1-866-762-2237. If you receive Medicaid through the Social Security Administration (SSA), call SSA at 1-800-772-1213.

Billing

  1. I have Medicaid and I'm receiving bills for services I have received.

    Call the AHCA Medicaid Help Line at 1-877-254-1055 for assistance.

Continuity of Care

  1. I have a prescheduled appointment under the plan I had last month, is my new plan going to cover it?

    To ensure individuals do not experience a break in services or care coordination, Managed Care plans and Fee for Service must provide continuity of care for up to 60 days for previously authorized or prescheduled services including:

    • Pre-Approved Appointments like provider appointments, dental appointments, surgeries, etc.
    • Pre-Approved Prescriptions, including prescriptions at non-participating pharmacies
    • Pre-Approved Behavioral Health Services.
    You should contact your current health plan to find out about Continuity of Care. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here for a list of the health plan phone numbers.

  2. What is Continuity of Care?

    COC requirements ensure that when enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition. The Agency has instituted the following COC provisions:

    Health care providers should not cancel appointments with current patients. Health plans must honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the roll-out date in each region.
    Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. Plans must pay for previously authorized services for up to 60 days after the roll-out date in each region, and must pay providers at the rate previously received for up to 30 days.
    Providers will be paid promptly. During the continuity of care period, plans are required to follow all timely claims payment contractual requirements. The Agency will monitor complaints to ensure that any issues with delays in payment are resolved.
    Prescriptions will be honored. Plans must allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after the roll-out date in each region, until their prescriptions can be transferred to a provider in the plan’s network.

  3. How long should health plans provide Continuity of Care?

    If an enrollee was receiving a service prior to moving to a new health plan, including those services previously authorized under the fee-for-service delivery system, the enrollee’s new health plan must continue to provide that service for up to 60 days after enrollment or until:

    For Managed Medical Assistance (MMA), the enrollee’s primary care practitioner or behavioral health provider reviews the enrollee’s treatment plan. In addition, the following services may extend beyond the 60 day COC period:
    • Prenatal and postpartum care for the entire course of pregnancy including postpartum care (six weeks after birth).
    • Transplant Services for one year post-transplant.
    • Oncology services including radiation and/or chemotherapy services for the duration of the current round of treatment.
    • Full course of treatment of therapy for Hepatitis C treatment drugs.
    For Long-Term Care (LTC), the enrollee receives a comprehensive assessment, a plan of care is developed, and services are authorized and arranged as required to address the LTC needs of the enrollee.
    The new plan cannot require any form of authorization and cannot require that the services be provided by a participating (in network) provider.
    Health plans are also responsible for the coordination of care for new enrollees transitioning into the plan. For more information on the SMMC program, visit: www.ahca.myflorida.com/smmc.

  4. I have a dental appointment scheduled but now my plan has changed? Can I still go to my appointment? Will it be covered?

    Dental plans must cover any ongoing course of treatment for up to 90 days after the new plan’s start date if it was authorized prior to enrollment into the new plan. This is called continuity of care. Active Orthodontia services go beyond the 90-day period, the services lasts until the completion of care.

Definitions

  1. What is a Medicare Advantage Plan?

    A Medicare Advantage Plan is a Medicare-approved health plan offered by a private company that covers both hospital and medical services, often includes prescription drug coverage, and may offer extra coverage such as vision, hearing, dental and/or wellness programs. Each plan can charge different out-of-pocket costs and have different rules for how to get services. Such plans can be organized as health maintenance organizations, preferred provider organizations, coordinated care plans, and special needs plans.

Enrollments / Plan Changes

  1. What is an Express Enrollment?

    Express Enrollment allows a DCF Applicant to be enrolled in a plan the day they become eligible for Medicaid. If a DCF Applicant for Medicaid does not select a plan, they will be assigned to one if they are required to be enrolled in an MMA plan to receive Medicaid services. Please make your plan selection today so you can be enrolled in the plan that best meets your needs when you are determined eligible. Click here to complete an Express Enrollment.

  2. Who can complete an Express Enrollment?

    Express Enrollment is for individuals that have never had Medicaid or for individuals that have not had Medicaid in the past 6 months. Click here to complete an Express Enrollment.

  3. I'm already enrolled and need to change my health and dental plan.

    You can change your health and dental plan during your initial 120 days of being enrolled or during your 60 day open enrollment. There are different ways to enroll. Click here to learn how to enroll/change plans.

  4. I changed my plan, when will it start?

    If Medicaid eligibility is active, plan changes during the 120 day change period will start on the first day of the following month. Plan changes completed during the 60 day open enrollment will start after open enrollment ends. For example: if open enrollment starts March 31 and ends May 29.

  5. When do I choose a Dental plan?

    A Dental plan may be changed during the following events:

    • Upon application for Medicaid
    • Initial 120 days after plan enrollment
    • Open Enrollment

  6. When do I choose an MMA plan?

    An MMA plan may be chosen during the following events:

    • Upon application for Medicaid
    • Initial 120 days after plan enrollment

  7. If my Long-term Care plan is also an MMA plan, can I choose it to be my MMA plan?

    Yes. You can only be enrolled into one plan. If you are eligible for both LTC and MMA, you will receive services through the same plan.

  8. What is "good cause"?

    This is a State-approved reason to change plans during the no change period.

  9. What is open enrollment?

    Open Enrollment is the 60-day period each year when you can change plans without state approval. Open Enrollment occurs yearly on the anniversary date of your first enrollment into the plan.

  10. What is the no change period?

    The no change period is the time period between the end of your initial first 120 days of enrollment and your 60-day annual open enrollment period. No change period also exists between your 60-day open enrollment periods going forward. Please refer to the below chart for reference. You will receive reminder letters assisting you with these time periods.
    Enrollment Date

  11. What if I want to change plans?

    If you have been approved for Medicaid, you may change your plan during the first 120 days of your enrollment. After the 120 days you will only be able to change your plan during your open enrollment period or with a State-approved good cause reason.

Health and Dental

  1. Am I required to have a dental plan?

    All Medicaid recipients, whether they are getting services through straight Medicaid or a MMA plan, are required to enroll in a dental plan. This includes Medically Needy and iBudget recipients. Please contact the State at 1-877-254-1055 for more information about enrollment in dental plans.

  2. What dental plans can I choose from?

    The dental plans available to Medicaid recipients are: DentaQuest, Liberty Dental, and Managed Care of North America (MCNA). Click here for a list of the dental plan phone numbers.

  3. What services are provided by the dental plans?

    Click here for a lists of dental services provided by the plans.

  4. How can I add or change the dentist?

    To add or change the dentist call your dental plan. Click here for a list of the dental plan phone numbers.

  5. I have a prescheduled dental appointment under the plan I had last month, is my new plan going to cover it?

    Dental plans must honor any ongoing course of treatment, for at least 90 days after the dental program starts in each region if it was authorized prior to the recipient’s enrollment into the plan. Please check with the dental plans, as some have extended this period beyond 90 days. Call your dental plan for more information on Continuity of Care. Click here for a list of the dental plan phone numbers.

  6. How do I apply for long-term care services?

    To apply for Long-term Care services contact the Elder Helpline at 1-800-96-ELDER.

  7. Who qualifies to receive long-term care services?

    Individuals that meet the following criteria are eligible to receive services under SMMC LTC:

    • Age 65 and over and eligible for Medicaid
    • Age 18 and over and eligible for Medicaid by reason of a disability
    • Individuals determined by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit at the Department of Elder Affairs to be at nursing home level of care and meet one or more established clinical criteria.
    To apply for Long-term Care services contact the Elder Helpline at 1-800-96-ELDER.

  8. What long-term care services are provided through Medicaid?

    Click here for a lists of long-term care services provided by the plans.

  9. What health plans can I choose from?

    Click here for a list of health plans in your area.

  10. What services are provided by health plans?

    Click here to see services covered by the health plans. If you don’t see the specific service listed, you can call your health plan directly. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here for a list of the health plan phone numbers.

  11. Is my medication covered by the health plan?

    You can call your health plan directly to find out if your medication is covered. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here for a list of the health plan phone numbers

  12. If I enroll in an MMA plan, will it change my enrollment in a Medicaid waiver?

    No. If you are enrolled in an MMA plan, your enrollment in a Medicaid waiver will not change and your waiver services will not change.

  13. Will enrolling into the MMA program cancel my Medicare?

    No, the MMA program will not cancel your Medicare. You are allowed to be enrolled in this program and Medicare at the same time because they cover different services.

  14. My child has braces. If I change plans, will they still be covered?

    Dental plans must cover any ongoing course of treatment for up to 90 days after the new plan’s start date if it was authorized prior to enrollment into the plan. This is called continuity of care. Active Orthodontia services go beyond the 90-day period, the services last until the completion of care.

  15. What services does my Dental plan cover?

    For children, comprehensive dental care, including medically necessary dental services. For adults, all State Plan dental services. Such as dental exams, dental screenings, dental X-rays, and extractions. Click here to see a list of benefits.

  16. What extra benefits does my Dental plan cover?

    All dental plans offer the same expanded (extra) benefits if you are 21 or older and with prior approval from your dental plan. Click here to see a list of expanded benefits.

  17. If I enroll in a Dental plan, will it change my enrollment in a Medicaid waiver?

    No. If you are enrolled in a Dental plan, your enrollment in a Medicaid waiver will not change and your waiver services will not change.

  18. Why does my MMA no longer cover dental?

    Florida Lawmakers asked the state (Agency For Healthcare Administration) to separate dental from the MMA plans and to cover the services under stand-alone Medicaid dental plans. Click here to see what dental plans are available.

  19. Will enrolling into the Dental program cancel my Medicare?

    No, the Dental program will not cancel your Medicare. You are allowed to be enrolled in this program and Medicare at the same time because they cover different services.

ID Cards

  1. I need another Medicaid Gold Card.

    To request a replacement Medicaid Gold Card, call the Department of Children and Families (DCF)1-866-762-2237. Those on Medicaid can print a temporary Medicaid card from their My ACCESS Account.

  2. I need another health plan ID card.

    To request a replacement health plan card, call your health plan directly. Click here for a list of the health plan phone numbers.

  3. I need another dental plan ID card.

    To request a replacement dental plan ID card, call your dental plan directly. Click here for a list of the dental plan phone numbers.

KidCare

  1. What is KidCare?

    Florida KidCare is the state’s children’s health insurance program for uninsured children ages 1-18, who meet income and eligibility requirements. MediKids, Florida Healthy Kids and Title XXI Children’s Medical Services Managed Care Plan compose the Title XXI Children’s Health Insurance Program (CHIP). CHIP is not an entitlement program and the families pay a monthly family premium of $15 or $20 depending on the family’s income. For more information call 1-888-540-5437.

  2. My children didn't qualify for Medicaid, I need to apply for KidCare.

    Call KidCare at 1-800-821-5437 or visit the website www.healthykids.org.

  3. My child is in the MediKids program (age 1-4) and I need to change the health and dental plan.

    Call The MediKids Helpline at 1-877-506-0578, or enroll online at https://flmedicaidmanagedcare.com.

  4. My child is in the Healthy Kids program (age 5-18) and I need to change the health plan.

    Call 1-800-821-5437 for more information about Healthy Kids.

Medically Needy / Share of Cost

  1. What is the Medically Needy Program?

    Individuals who are not eligible for "full" Medicaid because their income or assets are over the Medicaid program limits may qualify for the Medically Needy program. Individuals enrolled in Medically Needy must have a certain amount of medical bills each month before Medicaid can be approved. This is referred to as a "share of cost" and varies depending on the household's size and income. For more information call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida.

  2. What is Share of Cost?

    Individuals who are not eligible for "full" Medicaid because their income or assets are over the Medicaid program limits may qualify for the Medically Needy program. Individuals enrolled in Medically Needy must have a certain amount of medical bills each month before Medicaid can be approved. This is referred to as a "share of cost" and varies depending on the household's size and income. For more information call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida.

  3. I have questions about how "share of cost" works, what expenses count, or what proof is needed?

    For more information call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida.

  4. What medical services can I get with Medically Needy/Share of Cost?

    Medicaid covers a wide range of medical services, including hospitalization, doctor visits, prescription drugs and medical transportation, to name a few, that are provided by enrolled Medicaid providers. There are limitations and exclusions on some of these covered services. Call the AHCA Medicaid Help Line at 1-877-254-1055 for more information.

  5. I need to find doctors that work with Medically Needy/Share of Cost.

    Call the AHCA Medicaid Help Line at 1-877-254-1055, for assistance with doctors that work with Medically Needy/Share of Cost.

Member Portal

  1. Member Portal Express Enrollment

    Express Enrollment allows a DCF Applicant to be enrolled in a plan the day they become eligible for Medicaid. If a DCF Applicant for Medicaid does not select a plan, they will be assigned to one if they are required to be enrolled in an MMA plan to receive Medicaid services. Please make your plan selection today so you can be enrolled in the plan that best meets your needs when you are determined eligible. You can complete an Express Enrollment through the Florida MMA Member Portal.

Personal Information Updates

  1. I need to update my address, name, date of birth, or other personal information.

    If you receive Medicaid from the Department of Children and Families (DCF), you must call DCF at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida, to update your information. If you receive Medicaid from the Social Security Administration (SSA), you must call SSA at 1-800-772-1213, to update your address. If you pay a monthly premium for your children to be enrolled in MediKids or Healthy Kids, you must call Florida KidCare at 1-800-821-5437 or visit the website, www.healthykids.org, to update your information.

  2. What happens to my plan if I relocate or my address changes?

    If your address changes, you may need to select another plan if your region has changed. You may need to contact the Department of Children and Families (DCF) at 1-866-762-2237 or the Social Security Administration (SSA) at 1-800-772-1213 to report a change in address.

Pregnancy and Newborns

  1. I'm pregnant and need to apply for Medicaid.

    Call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida, to apply for benefits.

  2. I already have a health plan, but just found out I'm pregnant. Does my current plan cover pregnancy services?

    If you are a current Medicaid recipient and you become pregnant, your existing health plan will cover pregnancy services. Call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida to report your pregnancy.

  3. The doctor or hospital I want to go to for my pregnancy does not accept my current plan?

    Your current plan is responsible for providing a doctor and hospital you can see in your area. You can call your health plan directly and request a list of doctors in your area that work with your health plan. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here for a list of the health plan phone numbers. If your doctor or hospital accepts another Medicaid health plan, you can change your current plan if you are in your 120 day change period or if you are in open enrollment. Call the Florida Statewide Medicaid Managed Care Helpline at 1-877-711-3662 or visit http://www.flmedicaidmanagedcare.com to find out.

  4. Will my newborn have Medicaid coverage when they are born? What health plan will my baby have?

    Once your baby is born, call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida, to report the birth of your baby and activate the Medicaid. If you are enrolled in a health plan, your baby may be automatically enrolled into the same plan as you for the first month. To change the plan for your baby for the following month call the Florida Statewide Medicaid Managed Care Helpline at 1-877-711-3662 or visit http://www.flmedicaidmanagedcare.com to find out.

  5. Can I use the "Babyof" (e.g., BabyAofJane Smith) Medicaid card when I take my baby to the doctor?

    Cards initially issued to unborn babies contain the mother's name with "Babyof" (e.g., BabyAofJane Smith) and providers are able to use the card with its card control number to obtain the baby's Medicaid ID number. The Medicaid number will not be active until after the baby is born. Once your baby is born, call the Department of Children and Families (DCF), at 1-866-762-2237 or visit the website, www.dcf.state.fl.us/ess & www.myflorida.com/accessflorida, to report the birth of your baby and activate the Medicaid.

  6. I am pregnant.  How do I enroll my baby in my MMA plan?

    If you are not enrolled into a Specialty plan, the State will enroll your baby into the same MMA plan. This will begin when your baby is born. Please tell your MMA plan and your doctor that you are pregnant. Your MMA plan can help you get the care you need. If you are enrolled in a Specialty plan, your baby will be assigned to a different MMA plan.

  7. I am pregnant. How do I enroll my baby in my Dental plan?

    The State will enroll your baby into the same Dental plan. This will begin when your baby is born.

Providers

  1. I was automatically enrolled in a plan and need to add my doctor.

    You can call your health plan directly to add the doctor. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here for a list of the health plan phone numbers.

  2. I don’t want the doctor that is listed on my health plan card, who should I call to request another doctor?

    If you are happy with the health plan, and just want to change the doctor you can call your health plan directly. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here for a list of the health plan phone numbers.

  3. I want to change my doctor, but I don’t know what other doctors in my area work with my health plan.

    You can call your health plan directly and request a list of doctors in your area that work with your health plan. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here for a list of the health plan phone numbers.

  4. Why is a provider not showing in the system?

    Our system has the most up to date information available for providers through the plans. If the provider is not showing in the system this does not mean they do not accept the plan. You can call your health plan directly and request a list of doctors in your area that work with your health plan or select a primary care physician. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here to locate health plan phone numbers.

  5. The hospital I want to go to does not accept my plan.

    Your current plan is responsible for providing a doctor and hospital you can see in your area. You can call your plan directly to request a list of doctors in your area that will work with your health plan. Your health plan phone number is listed on your health plan ID card or you can click the following link to locate health plan phone numbers: flmedicaidmanagedcare.com/home/planphonenumbers. Alternatively, if your doctor or hospital accepts another Medicaid health plan, you can change your current plan if you are in your 120 day change period or if you are in open enrollment. Call the Florida Statewide Medicaid Managed Care Helpline at 1-877-711-3662 or visit http://www.flmedicaidmanagedcare.com to find out.

  6. I need to find a doctor that accepts Fee-for Service Medicaid (straight Medicaid).

    For a list of Fee-for Service Medicaid (straight Medicaid) doctors, you can call the AHCA Medicaid Help Line at 1-877-254-1055.

  7. The doctor I want to go to does not accept my plan.

    Your current plan is responsible for providing a doctor and hospital you can see in your area. You can call your plan directly to request a list of doctors in your area that will work with your health plan. Your health plan phone number is listed on your health plan ID card or you can click the following link fto locate health plan phone numbers: flmedicaidmanagedcare.com/home/planphonenumbers. Alternatively, if your doctor or hospital accepts another Medicaid health plan, you can change your current plan if you are in your 120 day change period or if you are in open enrollment.

  8. I need to find a specialist in my area that works with my plan.

    You can call your health plan directly to find out which specialists in your area work with your health plan. The health plan phone number is listed on your health plan ID card. If you need the phone number, click here for a list of the health plan phone numbers.

Special Conditions

  1. Specialty plan enrollment

    A specialty plan serves Medicaid recipients who meet certain criteria based on age, medical condition, or diagnosis. Recipients may be eligible for specialty services, including: Children with chronic conditions, Individuals with HIV/AIDS, Individuals with a serious mental illness and Children in child welfare. Please contact a Choice Counselor at 1-877-711-3662 to learn if you are eligible for a specialty plan.

  2. Special Needs

    All Managed Medical Assistance (MMA) plans cover people with special health care needs. There are also specialty plans that provide MMA services to eligible recipients who are defined as a specialty population based on age, medical condition, or diagnosis.

    • MMA Recipients who are eligible for specialty services, include: Children with chronic conditions, Individuals with HIV/AIDS, Individuals with a serious mental illness and Children in child welfare.

  3. I have a special health care need. Are there special plans that will cover my needs?

    Yes. All MMA plans cover people with special health care needs. There may also be special plans in your area for your health care needs. Also, if you have a child with a special health care need, the state’s Children’s Medical Services Network plan may be available to you. You may want to choose MMA plans that best meet your family’s needs.