Hundreds, maybe thousands, of Florida Medicaid kids at risk of losing care (2022)

Three weeks ago, the week before the Florida 2022 legislative session began, a reporter-friend from D.C. reached out to me with a story.

The private contractor that solely administers Florida’s Medicaid program for its sickest low-income children had stopped paying its bills. Now hundreds, potentially thousands, of children across the state were at risk of losing care.

My friend put me in contact with AnnMarie Sossong, a parent and nursing student in Marion County, Florida. Sossong told me about how she was stranded during the pandemic, with no one to help care for her disabled 15-year-old son. The company that dispatched caregivers to her home to help her son with his daily activities, like bathing and eating, had shut down.

The business shuttered because it hadn’t received payment from the state’s contractor for any of its 26 clients, including Sossong’s son, since Oct. 1 — about $144,000.

Now, Sossong and her husband were caring for their son, and she was considering leaving school because she couldn’t manage both her studies and his treatment.

In November, Sossong reported the problem to Sunshine Health, the insurance company that was responsible for paying for his care.

“They told me they’d get to it by January 31st,” Sossong told me by phone on Thurs. Jan. 13. “I’ve called every single other provider in the area. No one would take him.

“One guy talked to me at length, he’s the one who told me a lot of providers were shutting down because they weren’t getting paid.”

Sossong put me in touch with Lavette Gulley, the owner of the company Serenity Companion Service Inc, which had stopped visiting Sossong’s son because it hadn’t been paid.

Gulley told me on the morning of Mon. Jan. 10 that sheclosed on the first of the month. She said every single claim she had submitted to Sunshine Health since Oct. 1 had been denied. She said she was getting an attorney, and that she had been complaining to Sunshine since Oct. 25 with no effect.

“I have a screenshot where I stayed on the phone for eight hours and 15 minutes,” Gulley said. “I’m going to try not to cry. This has been really crazy.”

How many more Gulleys are out there? At least six.

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(Video) Will Medicaid Take My House?

In the past three weeks, I’ve talked to seven providers, including Gulley, who operate in 10 different counties across Florida, who’ve struggled to get paid by Sunshine since October. All seven providers have complained to Sunshine in the past three months, sometimes multiple times. Six providers also complained to the state. At least two providers also filed HIPAA violations with the state because one received the other’s patient authorizations, federally protected information. Many of them have also taken to Facebook, desperately seeking help and validation from their colleagues.

“Yes, ma’am, it is widespread,” Myron Scott, owner of Omega Behavior Analysis in Marion County, told me on Thurs. Jan. 13 regarding the data issues. “You can see that from the Facebook group.”

“It’s the whole state of Florida,” she continued. “I’ve got colleagues in Orlando and Miami and we’re all saying the same thing. … It seems like you call them and they're not even sure what to tell you, and just pass you along. It's like ping-pong."

Scott said she sees one CMS Medicaid child and hasn’t been able to bill for him through Sunshine since Oct. 1. “I still provide services for him, basically for free."

The seven providers together treat about 200 CMS Medicaid kids, according to my interviews. Of the 2.7 million kids on Medicaid, the CMS Medicaid plan is reserved for the sickest low-income children in Florida, including Sossong’s son. I asked the providers and Sossong to describe the CMS Medicaid kids: autistic, behaviorally challenged, disabled, immune deficient, medically complex.

I don’t know how many of these children are in jeopardy of losing access to care, or how many already have. But there are more than 85,000 of these children on the CMS Medicaid plan in Florida, according to stateDecember Medicaid enrollment data.

Sunshine’s responsible for paying for all of them.

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Steve Caton helps to run his wife Elise’s pediatric occupational and speech clinic called The Lamp Post Therapy Center in Alachua County.

“We have had 99% of our claims to Sunshine denied for fake reasons since the 10/1 merger,” Caton wrote to me by email on Mon. Jan. 17 regarding payment for services to Medicaid CMS children. “It’s beyond absurd what they are doing.”

Caton said that they see six CMS Medicaid kids at the clinic.

“The kids really rely on this therapy,” Caton told me by phone on Tues. Jan. 18. “I’m still seeing them but I’m getting really close to stopping doing that.”

***

What I learned in the last three weeks is that providers’ claims were being denied, in part, because Sunshine had made some grave data errors when it began administering Florida’s CMS Medicaid plan on Oct. 1.

Wellcare, a different health insurance company, had been managing the CMS Medicaid plan until Oct. 1. Then, Sunshine merged with Wellcare, and became responsible for the children’s care until its contract with the state ends in 2023.

It was during the merger with Wellcare that Sunshine screwed upwhat’s known asprovider credentialing data for the CMS Medicaid plan, causing providers to no longer get paid.

In Gulley’s case, Sunshine had mismatched her federal tax ID and national provider (NPI) code with her company name. As a result, her agency had been registered as a doctor’s office, which cannot provide services in patients’ homes, like her business does.

So, all of her claims were denied.

(Video) 9 Reasons NOT To Protect Assets From Nursing Home

Even though most of the providers I spoke with had complained to Sunshine and to the state, sometimes multiple times, in multiple ways, no one helped them for months.

None of the providers made traction until January, three months after the merger, when I started asking questions about what was going on.

Conveniently, the 2022 Florida lawmaking session is going on right now, so lawmakers and agencies are more accessible, and responsive, than usual…

***

After I got off the phone with Gulley on the morning of Mon. Jan. 10, I reached out to the Florida Agency for Health Care Administration, which regulates Medicaid in Florida, about what I was hearing.

Later that day, Gulley said, she heard for the first time from a person at the company who seemed intent on fixing her problems — Sunshine’s Chief Operating Officer Bill Kruegel.

On Wed. Jan. 12, after the Florida Senate Appropriations Subcommittee on Health and Human Services met for the first time this legislative session, I asked the chair, Sen. Aaron Bean (R-Fernandina Beach), if he was aware of the payment problems.

“I don’t think it’s a widespread problem because it’s the first I’ve heard of it,” Bean told me.

But when I approached Bean again about it after his committee met the following week, on Wed. Jan. 19, he told me he’d investigate.

That evening, one speech pathologist, Andrea Clark, decided to take a more direct approach.

Clark founded TherHappy Therapy Services, a speech, occupational and physical therapy nonprofit that sees 400 children, 120 of which are CMS Medicaid, in Hernando, Hillsborough, and Pasco counties.

Since Oct. 1, she had been receiving “a variety of unsubstantiated and inaccurate” denials for many of the CMS Medicaid children she treats for myriad services. She estimated Sunshine owed her upwards of $100,000, and said she would be forced toclose if she weren’t paid in the next month.

Clark had already sent letters complaining about the nonpayment issue to AHCA and to Kruegel at Sunshine but wasn’t making headway.

So, in the evening on Wed. Jan. 19, Clark said, a mutual friend emailed House Speaker Chris Sprowls (R-Palm Harbor) an executive summary describing the problem and the damages she had incurred.

The next morning, Clark said, she heard from AHCA Chief of Staff Cody Farrill, and the day after from AHCA Assistant Deputy Secretary for Medicaid Operations Brian Meyer.

“They said they were actively researching and looking into it,” Clark said on the phone on Sunday.

***

(Video) Dealing with the risks of Long-Term Care: Long-Term Care Insurance, Medicaid Planning, or both?

On the afternoon of Thurs. Jan. 20, Bean followed up with me by email.

“I reached out to the company directly and they acknowledged there is an issue, due to the merger and acquisition of Wellcare — that left some vendors not getting paid on time.

“I was told these invoices and claims should be processed by the end of this month.”

That same day, Kruegel, Sunshine’s COO, put out astatement on the company’s websiteacknowledging the problem for the first time.

“We recently discovered an IT issue impacting claims payments for some Children’s Medical Services Health Plan members after Sunshine Health’s operation of the health plan began on October 1, 2021,” Kruegel wrote. “We are diligently working to address the issue, and most of the impacted providers should have already started to receive payment for incorrectly rejected claims.”

Recentlydiscovered? Shouldn’t Sunshine have been aware of the issue for months? I called and texted a number I was given for Kruegel on Fri. Jan. 21, but I never heard back.

“Assoon as we were made aware of this issue, the Department of Health immediately addressed it directly with Sunshine Health,” Florida DOH spokesperson Weesam Khoury wrote to me by email on Thursday. (AHCA oversees Medicaid, but DOH oversees the CMS Medicaid plan.) “We are dedicated to ensuring all impacted providers receive immediate payment by the end of this month, as service providers play a critical role in protecting and caring for our vulnerable populations in Florida.”

Neither the state nor the company have given me details yet like how widespread the payment problem is or how many providers or Medicaid recipients have been affected.

***

Why did nothing happen until I, a member of the press, brought the case to Bean, a state senator and member of Republican leadership in that chamber?

Why did it take a letter to the House speaker before Clark got help on the matter?

What does this snapshot of Sunshine’s transition into managing the care of more than 85,000 medically needy children say about how Medicaid is being administered in general in Florida?

These are a few of the questions on my mind.

About a decade ago, Florida exported nearly the entire management of its$31 billion Medicaid programserving five million low-income people to a handful of companies like Sunshine Health — a subsidiary of the multi-national health company Centene, ranked #24 on theFortune 5002021 list.

Florida isone of 40 statesthat have privatized the public, mostly federally funded, entitlement program through this “managed care” system.

The private companies that now mostly manage Medicaid in Florida are middlemen, taking a monthly fee from the state to pay out all the claims for Medicaid services.

Whatever the companies don’t pay out for care, they pocket.

(Video) Understanding Florida Medicaid

So it would seem Sunshine wouldn’t have an incentive to fix these kinds of problems.

But,according to federal law, the company must spend at least 80 percent of its annual revenue on medical care, or issue rebates to its customers. The state will audit Sunshine sometime next year to review this year’s transactions.

Since 2018, the state has found Sunshine responsible for 45 Medicaid violations, levying $2.4 million in fines against it, the second highest penalty, according toAHCA compliance data. Nine of those violations were related to “network adequacy standards,” eight were related to “claims and provider payment,” and six of them were related to “untimely and/or inaccurate reporting.”

From 2014-2018, the state found Sunshine responsible for 88 violations and fined it $16 million in sanctions, by far the most, with the second-highest fine coming in at $9.3 million. It was penalized six times for performance measures and four times for failing to accurately report.

Alan Levine is a Tennessee-based hospital executive and the original architect of Florida’s managed care program. He told me by phone on Thursday that when he was AHCA secretary under former Republican Gov. Jeb Bush, he wanted to create the managed care program, in part, to help prevent Medicaid fraud.

“The idea was to shift the risk of fraud to the companies, and to pay them a fixed premium,” Levine said. “That would incentivize them to kick the bad guys out.

“I was trying to get the state out of the business of being an insurer, and in the business of paying insurers to do what they do — but also to regulate them.”

Levine said that the state can terminate its contract with Sunshine Health if they aren’t paying for medically necessary care or don’t have a proper grievance process.

“If they don’t have that, they are probably in violation of their contract with the state,” he said. “If I were the state, I’d send a team in to see what was going on.”

***

This story comes to an end, my friends, with both the good and the bad.

The good news is some providers are starting to get paid. The bad news is the providers who are getting paid are dealing with an administrative nightmare.

In Gulley’s case, she had to resubmit all the expired claims for her Marion home health agency.

“They’re on it, but they’re making me work too,” Gulley told me on the phone on Thurs. Jan. 20.

The next day, Gulley finally received a full month’s payment from Sunshine — $48,000 — enabling her on Monday to re-open.

Clark, the speech pathologist from Pasco, said she's been paid approximately $50,000 out of what she was owed by Sunshine in the last week, and isgrateful to the state for helping her recover it.

“I don’t believe that if the state had not specifically addressed these issues, they would have done what they have,” Clark said. “The state lit a fire under them.”

(Video) What you should know about Expanding Medicaid in Florida

FAQs

How long can a child stay on Medicaid in Florida? ›

Once the last child in the household turns 18 years of age, the parent(s) or other caretaker relative loses eligibility for coverage in Family-Related Medicaid.

Does my child qualify for Medicaid in Florida? ›

All children above the age of 1 are eligible for Florida KidCare coverage through a subsidized or full-pay program, even if one or both parents are working. Children from birth until their first birthday are eligible for Medicaid if their household income is below 200 percent of the federal poverty level.

What are income limits for Medicaid in Florida? ›

Florida Medicaid?
Household Size*Maximum Income Level (Per Year)
1$18,075
2$24,353
3$30,630
4$36,908
4 more rows

Does Florida Medicaid cover out of state emergencies? ›

Florida Medicaid reimburses the hospital so long as care meets one of the two following criteria: The emergency treatment is the result of an accident or illness while the recipient is out-of-state; Postponing services until returning to Florida will endanger the recipient's health.

Does Medicaid put father on child support Florida? ›

Medicaid. If you currently receive or have recently applied for Medicaid only, and you do not receive cash or food assistance, the Child Support Program will not automatically start child support services. If you want child support services, you will need to apply with the Child Support Program.

Does Florida Medicaid look at assets? ›

In Florida, Medicaid eligibility for long-term nursing home care is based on the assets and income of the Medicaid applicant, as well as the assets and income of the Medicaid applicant's spouse.

What is the highest income to qualify for Medicaid 2022? ›

Income Limit in Most States

Most states — 38 and Washington, D.C. — have the same income limit of $2,523 per month for a single person for most types of Medicaid services. For a married couple, the limit increases to $5,046 in most cases.

Is Florida Medicaid based on household income? ›

In Florida, if the household income of a person eligible for Medicaid is less than a certain percent of the Federal Poverty Level, that person meets the income requirements. These percentages change based on family size and eligibility group (e.g. pregnancy, age, or disability).

Is Florida Healthy Kids the same as Medicaid? ›

Florida KidCare is the umbrella brand for the four government-sponsored health insurance programs – Medicaid, MediKids, Florida Healthy Kids and the Children's Medical Services (CMS) Health Plan – that together provide a seamless continuum of coverage for Florida children from birth through the end of age 18.

What is the Medicaid income limit for 2022 in Florida? ›

Effective Jan 1, 2022, the applicant's gross monthly income may not exceed $2,523.00 (up from $2,382.00). The applicant may retain $130 per month for personal expenses. However, even having excess income is not necessarily a deal-breaker in terms of Medicaid eligibility.

Does Florida Kidcare verify income? ›

REQUIRED ARE THE FOLLOWING:

Pay stubs, or. W-2, or. Other documents.

What is the highest income to qualify for Medicaid? ›

Federal Poverty Level thresholds to qualify for Medicaid

For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight. To calculate for larger households, you need to add $4,720 for each additional person in families with nine or more members.

Can doctors refuse Medicaid patients? ›

If you are a private practice doctor, you DO NOT HAVE TO accept Medicaid or Medicare patients. Many physicians will not accept Medicare/Medicaid patients because of the low reimbursement rates and late payments.

Can you charge a no show fee to a Medicaid patient in Florida? ›

Federal and state policies prohibit charging Medicaid members for missed or canceled appointments.

Which state has the best Medicaid program? ›

States with the Best Medicaid Benefit Programs
RankStateTotal Spending Per Person
1New York$12,591
2New Hampshire$11,596
3Wisconsin$10,090
4Minnesota$11,633
46 more rows
16 Jun 2020

What percent of a father's income goes to child support in Florida? ›

In a nutshell, the noncustodial parent is authorized to pay the custodial parent monthly child support ranging 40%-60% based on their income calculations, as per family law of Florida.

Is Florida a pro dad State? ›

Are Florida Courts Biased Against Fathers When Awarding Custody? Many fathers assume that Florida courts automatically favor the mother when awarding child custody. However, Florida courts cannot make custody decisions based on gender.

Is Florida a dad State? ›

There is a common myth that the law favors mothers in child custody cases. But Florida law has no preference for either parent when it comes to custody and parental rights.

Does Medicaid check your bank account in Florida? ›

While Medicaid agencies do not have independent access to a Medicaid recipient's financial statements, Medicaid does an annual update to make sure a Medicaid recipient still meets the financial eligibility requirements. Furthermore, a Medicaid agency can ask for bank statements at any time, not just on an annual basis.

What is the 5 year rule in Florida? ›

In order to qualify for long-term Medicaid in Florida, such as nursing home or assisted living care, the applicant must not have given away (i.e., made "uncompensated transfers") assets within five years of applying for Medicaid benefits. This is generally known as the Medicaid “look-back” period.

How do I avoid Medicaid 5 year look back in Florida? ›

Paying off debt.

You can pay off an unlimited amount of your personal (or joint) debt without violating the Medicaid lookback rules. This includes paying off your mortgage or HELOC on a residence that you may be eligible to transfer to another person.

Which state has highest income limit for Medicaid? ›

The state with the highest income limits for both a family of three and individuals is Washington, D.C. If you live in this area, a family of three can qualify for Medicaid if their income is at 221% of the FPL.
...
Medicaid Income Limits by State 2022.
StateParents (Family of 3)Other Adults
Wyoming54.00%0.00%
49 more rows

Does medical look at savings account? ›

After January 2024, the ownership of a home, more than one vehicle, or the amount of money and savings in a banking account, will not be taken into account for Medi-Cal benefts. Q: Will Medi-Cal income limits change? No, this change applies only to the Medi-Cal asset limit.

What are the qualifications for Medicaid? ›

Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.

What assets can Medicaid take in Florida? ›

Countable Assets for Long-Term Medicaid

All financial accounts (bank accounts, CDs, brokerage accounts, bonds, etc.) Jointly held accounts (even if a co-owner is on the accounts, the asset is 100% countable to the applicant) Cash value in life insurance policies (but only if the policy face value exceeds $2,500)

Who is not eligible for Medicaid in Florida? ›

Able-bodied, non-elderly adults who don't have dependents are not eligible for Medicaid in Florida, regardless of how low their income is. Florida's eligibility standards are: Children up to 1 year old: 206% of the federal poverty level (FPL) Children ages 1-5: 140% of FPL.

What is the income limit for food stamps 2022 in Florida? ›

For a household of one person, the maximum net income is $1,074, or 100% of poverty level. For a family of four, the maximum net income limit in Florida is $2,209. A family of four in Florida would receive a maximum of $835 per month in 2022 in SNAP benefits.

Is Florida Healthy Kids Medicare or Medicaid? ›

Florida Healthy Kids has a subsidized plan for families who exceed the income eligibility threshold for Medicaid, as well as full-pay options available for those who don't qualify for subsidized coverage.

Will DCF take my newborn in Florida? ›

In most cases of substance exposed newborns, DCF takes emergency custody of the baby to keep the baby safe until the investigation is completed and a determination is made about whether you can safely care for your baby.

What does Medicaid cover for children in Florida? ›

Medicaid and the Children's Health Insurance Program (CHIP) provide no-cost or low-cost health coverage for eligible children in Florida. These programs provide health coverage for children so that they can get routine check-ups, immunizations and dental care to keep them healthy.

How does Florida Kidcare determine income? ›

Monthly premiums depend on your household's size and income. Children in families with income between 133 percent and 200 percent of the federal poverty level ($35,256 and $53,016 for a family of four) are eligible for subsidized coverage through Florida Healthy Kids.

Can you own a home and still qualify for Medicaid in Florida? ›

If the applicant is an owner of a primary home meeting the criteria, Medicaid will ignore that resource. They will therefor not place a lien on your home during the application process. Do not gift or transfer your primary residence or other real estate to someone for less than fair market value.

What is considered low income for a family of 3 in Florida? ›

Income Limits Effective April 18, 2022
Family SizeExtremely Low Income 30% of AMIVery Low Income 50% of AMI
2$23,400$39,000
3$26,350$43,900
4$29,250$48,750
5$32,470$52,650
5 more rows

How does Florida Medicaid verify income? ›

Documentation of income might include any of the following: Most current pay stubs, award letter for Social Security, SSI, Railroad Retirement, or VA, pension statement, alimony checks, dividend checks, a written statement from one's employer or from a family member who is providing support, or an income tax return.

What is the income limit for child care assistance in Florida? ›

The measure would, among other things, increase the eligibility limit to 70 percent of state median income, or $54,109 for a family of four (up from $39,750 in current law). On February 7, 2022, the bipartisan bill passed out of its first committee with unanimous support.

What is the income limit for ELC in Florida? ›

Eligibility is determined by both income and family size. Families who earn up to 150% of the Federal Poverty Level (FPL) may qualify and may remain funded up to 85% of the State Median Income (SMI). For example, a family of three could earn up to $31,170 a year and still qualify to begin services.

What is the federal poverty level for 2022? ›

Federal Poverty Level (FPL)
Family size2021 income number2022 income numbers
For individuals$12,880$13,590
For a family of 2$17,420$18,310
For a family of 3$21,960$23,030
For a family of 4$26,500$27,750
5 more rows

What is the income limit? ›

Income Limits means limits on income set by HUD used as one of determining eligibility factors for Federal and State housing assistance programs. Definitions for very low, low, and moderate income vary by program and are determined by the gross household income and household size.

What is 400% of the poverty level? ›

Percentages Over 2022 Poverty Guidelines
Family Size100%400%
1$13,590$54,360
7$41,910$167,640
8$46,630$186,520
For each additional family member$4,720$18,880
5 more rows

What are the disadvantages of Medicaid? ›

Disadvantages of Medicaid

They will have a decreased financial ability to opt for elective treatments, and they may not be able to pay for top brand drugs or other medical aids. Another financial concern is that medical practices cannot charge a fee when Medicaid patients miss appointments.

Does Medicaid cover surgery? ›

When it comes to surgical procedures, both Medicare and Medicaid provide coverage for many medically necessary surgical services received under inpatient and outpatient treatment. However, coverage terms can vary depending on the type of surgery being performed, where it is performed, and your specific circumstances.

Is Medicaid unconstitutional? ›

In National Federation of Independent Business v. Sebelius , a decision that will stand as a landmark in American social policy, the US Supreme Court upheld the constitutionality of the Affordable Care Act.

Do you have to pay back Medicaid in Florida? ›

My answer to him was that he was correct - Florida Medicaid does have a pay back provision, just like all states. During your lifetime, if you receive Medicaid benefits, if you die after age 55, the State of Florida is a creditor in your estate.

Can you charge full price for no show? ›

Generally, businesses cannot charge you the full price for services that were not performed, such as a tire change or a haircut. They may charge a percentage of the service or a set fee for you canceling or being a “no call, no show," but they cannot charge the full amount for services not rendered.

Can you balance bill a Florida Medicaid patient? ›

If your insurance* provider is from Florida, then you can't be balance billed for emergency services. You are only responsible for paying your copay, deductible and coinsurance.

What state is the hardest to get Medicaid in? ›

Main Findings
Overall RankStateEligibility & Enrollment
1Massachusetts12
2Rhode Island2
3Vermont16
4Pennsylvania21
46 more rows
15 Mar 2021

Who is the largest Medicaid provider in the US? ›

Centene Corporation, a Fortune 500 company, is a diversified, multinational healthcare firm providing a portfolio of services to government-sponsored healthcare programs, focusing on uninsured and underinsured individuals. It is currently the largest Medicaid managed care organization in the country.

How long is Florida Medicaid? ›

It may take up to 30 days to process your application (longer if you need a disability determination). Visit What happens next to learn more.

What are Medicaid rules in Florida? ›

To be eligible for Florida Medicaid, you must be a resident of the state of Florida, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

Do you have to renew Medicaid Every year Florida? ›

Don't Forget to Renew Each Year

Recertify your Medicaid coverage every 12 months to keep your benefits. Visit the Florida Department of Children and Families to sign up for email reminders.

Why is Florida Medicaid so hard to get? ›

Income limits to qualify for Medicaid in Florida are very low, and most adults who don't have children aren't eligible to enroll.

Do you have to pay Medicaid back in Florida? ›

This is commonly known as the Medicaid "pay back" or reimbursement provisions, and many people are unaware of this provision in the law. My answer to him was that he was correct - Florida Medicaid does have a pay back provision, just like all states.

What is the highest income to qualify for Medicaid 2022 Florida? ›

In Florida, Medicaid applicants in 2022 are required to make less than $2,523.00 in gross income, with some deductions considered, in order for their application to be successful. However, if total gross income exceeds this amount, even by a dollar, the application will be denied.

Does CVS Take Florida Healthy Kids? ›

— Aetna Better Health of Florida, a CVS Health company (NYSE: CVS), has been awarded a new, statewide contract by the Florida Healthy Kids Corporation, a Florida Kidcare partner, to provide managed care to Florida Healthy Kids eligible enrollees.

Does Medicaid cover dental? ›

Dental services are a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

What is the look back period for Medicaid in Florida? ›

In order to qualify for long-term Medicaid in Florida, such as nursing home or assisted living care, the applicant must not have given away (i.e., made "uncompensated transfers") assets within five years of applying for Medicaid benefits. This is generally known as the Medicaid “look-back” period.

Can you have Medicaid and private insurance in Florida? ›

You can have Medicaid and private health insurance at the same time, and there are some advantages and disadvantages to doing so. In many cases, if you're eligible for both Medicaid and private insurance, your private insurance plan will be the primary coverage, and your Medicaid coverage will be supplemental.

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