Medicaid State Plan

Medicaid is the state and federal partnership that provides health coverage for selected categories of people with low incomes. Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children. Medicaid is different in every state. Eligibility for Medicaid is determined by the following agencies:

The Social Security Administration (SSA) determines eligibility for Supplemental Security Income (SSI);

The Florida Department of Children and Families (DCF) determines eligibility for low-income children and families, aged persons, disabled persons, and persons seeking institutional care;

Florida Healthy Kids Corporation determines eligibility for MediKids.

The Florida Medicaid Summary of Services booklet is intended to be a quick reference to Medicaid services.

This summary provides an overview of Florida Medicaid services as well as information on Medicaid eligibility and managed care programs.

Everyone should refer to the Florida Medicaid Provider General Handbook or the service-specific Coverage and Limitations and Reimbursement Handbooks for more detailed information about Florida Medicaid. Listed below are some of the most used handbooks for individuals with Medicaid. The total list of Medicaid handbooks may be located at here.

Child Health Check

The Purpose of the Child Health Check–Up program is to provide the following services to children from birth through age 20:

  • Comprehensive, preventive, well child care on a regularly scheduled basis;
  • Identification and correction of medical conditions before the conditions become serious and disabling; and
  • An entry into the health care system.

Home Health

Home health services are medically necessary services, which can be effectively and efficiently provided in a recipient’s residence. Services include home health visits (nurse and home health aide), private duty nursing and personal care services for children, therapy services, medical supplies, and durable medical equipment.

Therapy Services

The purpose of the therapy services program is to provide medically necessary physical therapy (PT), occupational therapy (OT), respiratory therapy (RT) and speech-language pathology (SLP) services to recipients from birth through age 20.

The therapy services program also provides services to recipients age 21 and older for SLP services pertaining to the provision of augmentative and alternative communication systems, and PT and OT services pertaining to wheelchair evaluations and fittings. These are the only services in the therapy program that Medicaid reimburses for adults.

PPEC

The purpose of the Florida Medicaid Prescribed Pediatric Extended Care (PPEC) Services Program is to enable children with medically-complex conditions to receive medical care at a non-residential pediatric center. PPECs provide a cost effective and less restrictive alternative to private duty nursing (PDN) or institutionalization, and reduce the isolation that homebound children may experience. Private duty nursing may be provided as a wraparound alternative for an individual needing additional services, when PPEC is not available.

A PPEC is a non-residential facility that serves three or more children under the age of 21 who require short, long-term, or intermittent medical care due to medically-complex conditions. A PPEC offers services that meet the child’s physiological, developmental, nutritional, and social needs.