Florida Medicaid Covered Services

Physician, Physician Assistant and Advanced Registered Nurse Practitioner (ARNP) Services:
- Diagnosis and treatment of illness, injury or disease, including Adult Health Screenings and Child Health Check-Ups.

Hospital Services:

Inpatient: - Ages 0 thru 20: No limits on number of days. - Ages 21 & Over: Limit of 45 days per state fiscal year (7/1 6/30). Outpatient: - Ages 0 thru 20: No limits on dollar amount. - Ages 21 & Over: Limit of $1,500 per beneficiary per state fiscal year (7/1 6/30). Dialysis, chemotherapy, radiation therapy, and surgery are exempt from the $1,500 limit for adults. - - - - - - - - - - - - - Medications listed on the Medicaid Preferred Drug List (PDL) must be used before requesting approval to use non-PDL medications. No limit on the number of generic or brand-name drugs if they are on the Preferred Drug List. Mental Health drugs are not exempt from PDL requirements. Nursing home residents are not exempt from PDL requirements. All HIV anti-retrovirals are on the Preferred Drug List. Screening, x-rays and manual manipulation of the spine is limited to 24 visits per member per calendar year. Behavioral health services, including outpatient therapies, emergency services and inpatient psychiatric hospitalization are available through your approved behavioral health provider organization. Contact your local Medicaid Office regarding the service providers in your area.

Prescribed Drug Services:

Chiropractic Services:

Community Behavioral Health Services:

Dental Services:

Ages 0 thru 20: Diagnostic, preventive, therapeutic and emergency dental services. Ages 21 & Over: Emergency services for the relief of pain or infection which may include emergency exam, necessary x-rays, extractions, incisions and drainage procedures for the relief of an abscess. Full dentures, partial dentures and denture related services. All Ages: Medically necessary hearing evaluations, dispensing fees, hearing aid devices, hearing aid repairs, cochlear implant devices and repairs. Private duty nursing, therapy, and medical supplies by an RN, LPN or Nurses Aide. Limitations apply to certain services and age groups. Medically necessary treatment of the foot and leg. A non-residential pediatric center that enables children through age 20 with medically-complex conditions to receive nursing care, and offers services to meet the childs physiological, developmental, nutritional and social needs. Transportation to receive a Florida Medicaid covered medical service when no other transportation is available.

Hearing Services:

Home Health Services:

Podiatry Services:

Prescribed Pediatric Extended Care (PPEC) Facility:

- -

Transportation Services:

Visual Services:
- -

All Ages: Medically necessary visual examinations, fitting, dispensing and adjustment of eyeglasses; repairs, refractions, prosthetic eyes and related services, and medically necessary contact lenses. Two examinations and pairs of glasses per beneficiary every 365 days. Second pair must be medically necessary. Specialized services for the prevention of institutionalization: Project AIDS Care, Aged/Disabled Adult, Developmental Disabilities, Traumatic Brain/Spinal Cord Injury, Assisted Living for the Elderly, Adult Cystic Fibrosis, Family and Supported Living, Nursing Home Diversion, Channeling, Alzheimers Disease, Adult Day Health Care, Model Waiver, and Consumer Directed Care. In addition, the state has a family planning waiver program.

Waiver Programs:

Florida Medicaid offers additional medical services and programs. Your local Florida Medicaid office can provide this information or you can visit our website at http://ahca.MyFlorida.com. This is not a legally binding document and is not to be relied upon for specific information.

Healthy Outcomes
Here are some suggestions provided by your local Florida Medicaid office on how you can be more involved in your health care.
If you are enrolled in MediPass, you need to choose your own health care
provider. If you do not make a selection, one will be chosen for you. Your MediPass provider must approve visits to a specialist, except dental, vision, and family planning. Emergency room care is also approved by your MediPass provider, except in cases of serious medical emergency.

Your primary care provider has the responsibility to evaluate and advise you
about your total health care and is your gateway to good health. A positive relationship with your health care provider, based on mutual respect and trust, is the foundation of healthy outcomes for you and your family.

It is important that you keep appointments and be on time. If you need to cancel
or delay an appointment, please let your provider know as soon as possible.

Remember to fully inform your health care provider of your medical

problems, medications and concerns. Expect a complete explanation from your health care provider in terms that you can understand before any treatment begins. While you have the right to refuse treatment, make sure you understand the consequences.

Ask for information about your medicines in terms you can understand

both when they are prescribed and when you receive them. Labels can be hard to understand. If you have questions about the directions, ask.

Privacy is an expectation and a right. Your records and conversations

will be kept confidential. It is important that you assist your health care provider to obtain previous medical records so that your provider has complete medical information.

If you suspect your provider is overcharging you, improperly billing you,

or providing unnecessary treatment, your local Florida Medicaid office will investigate your claim on your behalf.

The Florida Department of Children & Families (DCF) holds fair hearings

for Florida Medicaid members who disagree with the decision regarding eligibility, denial of services, etc. You may request a hearing through your local DCF or Florida Medicaid office.

Your local Florida Medicaid office can advise you further on your rights,

responsibilities, and choices. Florida Medicaid information is also available on the internet at http://ahca.MyFlorida.com.

Revised July 2006

A HEALTH CARE SYSTEM