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    OpenPayerPolicy UpdatesAdministrative/Operational PolicyAHCA Medicaid Managed Care Policy Update | OpenPay…
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    RetiredAgency for Health Care AdministrationPolicy 11-W-00206/4

    Managed Medical Assistance Program

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    This document lists statutory waivers that authorize Florida to operate its Managed Medical Assistance Program under the Section 1115 demonstration. It affects Florida Medicaid administration, managed care plans, provider-sponsored networks, and Medicaid beneficiaries during the stated approval period.

    Policy Summary
    PayerAgency for Health Care Administration
    PolicyManaged Medical Assistance Program
    Policy CodePolicy 11-W-00206/4
    Change TypeNo material change
    Effective DateJuly 31, 2014
    Next Review DateNot specified
    Key ActionApply the listed statutory waivers to Florida's Managed Medical Assistance Section 1115 demonstration.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2014–2017Approval period
    4Title XIX waivers listed
    FLState covered
    06/30/2015Certain waiver authorities expire

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    Title XIX Waivers

    Title XIX Waivers

    The following Title XIX waivers apply to Florida’s Managed Medical Assistance Section 1115 demonstration, subject to the stated limitations and expiration dates.

    Statewideness/Uniformity

    • Florida may operate the demonstration and provide managed care plans or certain types of managed care plans, including provider-sponsored networks, only in certain geographical areas.

    Amount, Duration, and Scope and Comparability

    • Florida may vary the amount, duration, and scope of services offered to individuals, regardless of eligibility category, based on differing managed care arrangements or, in the absence of managed care arrangements, as long as the benefit package meets the applicable actuarial benefit equivalency and benefit sufficiency requirements.
    • The waiver does not permit limitation of family planning benefits.
    • Florida may offer different benefits to demonstration Population A than to the categorically needy group through June 30, 2015.

    Income and Resource Test

    • Funds in an enhanced benefit account may be excluded from the income and resource tests established under state and federal law for purposes of determining Medicaid eligibility.

      This authority expires June 30, 2015.

    Freedom of Choice

    • Florida may require mandatory enrollment into managed care plans with restricted networks of providers.
    • The waiver does not authorize restricting freedom of choice of family planning providers.

    Statutory Authorities and Approval Periods

    Statutory authority cited for Statewideness/Uniformity waivermixed
    1902(a)(1)Statewideness/Uniformity provision
    Statutory authority cited for benefit variation waivermixed
    1902(a)(10)(B)Amount, Duration, and Scope and Comparability provision
    1902(a)(17)Amount, Duration, and Scope and Comparability provision
    Statutory authority cited for income and resource test waivermixed
    1902(a)(10)(C)(i)Income and Resource Test provision
    Statutory authority cited for freedom of choice waivermixed
    1902(a)(23)(A)Freedom of Choice provision
    Demonstration approval period
    Approval startJuly 31, 2014
    Approval endJune 30, 2017
    Approval periodJuly 31, 2014 through June 30, 2017
    Expiration of certain waiver authorities
    Expiration dateJune 30, 2015
    Authorities affectedBenefit variation waiver for demonstration Population A and the categorically needy group; Income and Resource Test waiver
    Income and resource test authorityAuthority to exclude enhanced benefit account funds from Medicaid income and resource tests expires June 30, 2015
    Policy Summary
    PayerAgency for Health Care Administration
    PolicyManaged Medical Assistance Program
    Policy CodePolicy 11-W-00206/4
    Change TypeNo material change
    Effective DateJuly 31, 2014
    Next Review DateNot specified
    Key ActionApply the listed statutory waivers to Florida's Managed Medical Assistance Section 1115 demonstration.
    SourceLink
    On This Page
    Title XIX WaiversStatutory Authorities and Approval Periods