APPLYING FOR FLORIDA MEDICAID
Most likely you’ve heard of the 10 commandments, the 11th commandment is:
Never, ever file a Florida Medicaid application until you are sure that you qualify or it is strategically beneficial to be denied!
You should submit a FL Medicaid application 90 days or more prior to the date that they believe the loved one will be eligible for benefits, given the current delays in the Medicaid approval process.
A Florida Medicaid application requires a mountain of paperwork, and is then submitted to an overwhelmed and sometime adverse government processing system, which makes filing an application for public benefits an enormous project.
Present the information in a way that it can be easily understood by FLorida Medicaid officials. (Florida AHCA)
When applying for Medicaid or other public benefits, there are often many hidden potholes, obstacles, and dangerous curves in the road.
General Information on Applying for Medicaid in FL
Medicaid Applications in Florida
The pile of paperwork required and sometimes inefficient government processing system can make filing an application for public benefits an enormous project. Although the federal government shares the cost of funding the Medicaid program with the State of Florida and requires the state government to uphold certain standards with respect to efficiency and the granting of Medicaid applications, it is not uncommon for a state or county office to fail to meet the federally imposed guidelines.
Therefore, when applying for Medicaid or other public benefits, it is crucial for applicants to be well prepared and well versed in the implications of all information to be supplied in support of the application.
Following is a sample list of Medicaid application issues which should be addressed to avoid unnecessary delays and denials.
1. Timeliness of Filing Your Florida Medicaid Application
It is important that applicants do not apply for Medicaid prematurely. Strategies for Medicaid planning often include triggering a penalty period for FL Medicaid eligibility purposes. While the time in which to wait to file an application may be more or less than five years, filing an application during a period of ineligibility could potentially cause a significant delay in the applicants eligibility approval status. It is, therefore, important to check with a qualified professional as to the date after which the application may be filed.
2. Authorization to Apply
In most cases, the applicant himself or herself is unable to visit the County social services office and offer detailed information on his/her financial status. The law, therefore, specifically provides that a relative, welfare agency staff member, staff member of the institution in which the applicant resides, or a professional may apply on the applicant’s behalf. Because the Medicaid eligibility laws and policies are rapidly changing, subject to shifts in politics and lobbying by advocates for the elderly, applicants are well advised to retain individuals with comprehensive knowledge of the Medicaid eligibility rules and all strategies that may be legally employed to expedite eligibility.
3. Physical Criteria for Medicaid Eligibility
Qualifying for FL Medicaid involves not only financial criteria, but also physical requirements. Therefore, applicants must demonstrate through a physical exam that he or she is unable to perform the activities of daily living, including feeding, dressing, bathing, toileting and continence. If it cannot be shown to Medicaid that the care is medically necessary, the Medicaid application will be denied.
4. Substantiating the Data Needed for Approval of a Medicaid Application
The Medicaid application itself is several pages, and the answers to each question must be substantiated by legal or financial documentation. These supporting documents include: social security cards, Medicare cards, health insurance cards, birth certificates, marriage certificates, death certificates, life insurance policies, deeds, car registrations, household expense bills, funeral arrangement documents, pay or pension stubs, and financial statements typically dating back five years prior to the time the Medicaid application is filed.
Each Medicaid office in Florida has a computer program to verify social security numbers, employment history, or other personal information. Likewise, if any financial information is not disclosed to a county social service office, the office may deny the application based on information it periodically receives from the Internal Revenue Service. Intentional failure to disclose relevant financial data is considered Medicaid fraud. Even in cases where Medicaid eligibility has initially been granted, the county welfare office may revoke the approval upon receiving the IRS records.
5. Additional Documentation and County Verification for Medicaid Eligibility
The requirement that financial statements dating back five years prior to the filing of the application be submitted also varies from county to county. Depending on the circumstances, some counties have been known to request as little as forty-two (42) months of statements.
Florida’s Medicaid State Plan (the Plan) is a large, comprehensive written statement describing the scope and nature of the Medicaid program. The Plan outlines current Medicaid eligibility standards, policies and reimbursement methodologies to ensure the state program receives matching federal funds under Title XIX of the Social Security Act.
The mission of the Medicaid Program Oversight (MPO) is to monitor, analyze and validate encounter data submissions from Medicaid Health Plans to enhance system processes for collecting and reporting encounter data, to determine Health Plans’ compliance with contractual requirements, and to measure health outcomes. To that end, MPO collects, processes, stores, reports and analyzes the encounter data from managed care service activities and prescription drug utilization for all Florida Medicaid capitated Health Plans. MPO also supports rate development and the risk model computations that set capitated payments for managed health care entities as defined in the Florida Medicaid Reform contracts.
To file a health care facility complaint, call (888) 419-3456, or click here to complete the Health Care Facility Complaint Form. Click here to search our FloridaHealthFinder.gov site to see if the facility you have concerns about is one that is regulated by our Agency.
To file a Medicaid fraud and abuse complaint, call (888) 419-3456, or complete the Medicaid fraud complaint form.
To request a publication, call (888) 419-3456. Many publications are available for viewing and printing on our AHCA Publications page.
For more information on our hotline, please visit Consumer Complaint, Publication and Information Call Center.
You can find an office near you using our Regional Maps.
To contact specific bureaus or departments, please look Inside AHCA for the department you require.
To contact specific bureaus or department, including those which license Florida health care providers, please look Inside AHCA for the department you require
For questions or information, you may contact the Agency for Health Care Administration by feedback form or by phone toll-free at (888) 419-3456, or by mail at:
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, FL 32308