Florida Medicaid Reform

Provider Information - Year 7 (July 1, 2012 – June 30, 2013)
Broward, Duval, Baker, Clay, and Nassau Counties

Florida Medicaid Reform Health Plan Application

The revised Application for Medicaid Reform Fee-For-Service Provider Service Networks (PSNs), Prepaid PSNs, Health Maintenance Organizations (HMOs) and other authorized Health Plans and the Reform Health Plan Contracts is now available. This multi-purpose Health Plan Application is designed to capture detailed information that will facilitate a contract between the Agency and any PSN, HMO or other authorized Health Plans that meet the requirements to become a Medicaid Reform Health Plan.

Medicaid Reform Health Plan Application, July 2011 [691KB PDF]

2012-2015 Medicaid Managed Care Contract

Florida Medicaid Reform Health Plan Expansion Application

Please be advised that health plan expansion requests received after June 1, 2012, are not likely to be fully reviewed and approved prior to the release of the procurement documents for Statewide Medicaid Managed Care.

Health plans that already serve Medicaid enrollees through a Reform plan may now apply to expand services to other Reform counties. The counties are Clay, Baker, Nassau, Duval and Broward. Plans that seek to expand to Clay, Baker or Nassau must serve all three counties.

The expansion application requires updates on any information that has changed since execution of the Reform plan contract the plan's original Reform application as well as new information for the expansion counties.

Medicaid Reform Health Plan Expansion Application, July 2011 [219KB PDF]

2012-2015 Medicaid Managed Care Contract

Disclosure of Ownership and Control Interest Statement (CMS-1513)

A completed Disclosure of Ownership and Control Interest Statement (CMS 1513), is required for all Florida Medicaid Reform health plan applicants. To obtain a copy of the form, please click on the link below.

Disclosure of Ownership and Control Interest Statement (CMS-1513) [550KB PDF]

Florida Medicaid Reform Data Book

Please contact John Churchill at: John.Churchill@ahca.myflorida.com

Florida Medicaid Reform Plan Evaluation Tool

Please contact John Churchill at: John.Churchill@ahca.myflorida.com

Revised Reform Capitation Rates

The Revised Reform Rates for Broward (Area 10), and Duval, Baker, Clay and Nassau (Area 4) are found below. As rates are calculated by Area, the Area 4 rates cover all counties in Area 4, and therefore the counties of Duval, Baker, Clay, and Nassau have the same rates. 

Medicaid Reform Capitation Rates Effective Sept 2012 [155KB PDF]

Contact Information for Florida's Medicaid Providers

Medicaid Health Plans