Medicaid Resource Guides

(This applies to Florida only) 

AHCA recently mandated each Medicaid health plan develop provider resource guides to provide instructions and contacts regarding their wide range of services. Each plans resource guide covers:

• Behavioral Health
• Case Management
• Perinatal Care
• Pharmacy
• Subcontracted Services
• Transportation
• Utilization Management

The goal is to improve communication and coordination between the health plan and their providers. As well as, provide a better experience for the members. Reducing hospitalizations and increasing access to services following post-acute discharge are among the main goals for this initiative.

Each Plan’s resource guide is on their website, or can be found at the link below. They can also be found on the MCCFL portal. Please do not hesitate to contact your liaison with any questions. 

Cost Based Managed Care Plans

(This applies to ALL states) 

Cost Based Managed Care Plans

Have you come across a ‘Cost Based Plan’? Medicare Cost Plans are a type of Medicare Health Plan available in limited areas of the country. Similar to Medicare Advantage Plans, Medicare Cost Plans are offered by private companies and may include extra coverage. However, unlike Medicare Advantage Plans, a Medicare Cost Plan does not replace the members original Medicare coverage, it offers their benefits in addition to those of original Medicare. These plans give flexibility to use out of network health care providers and usually cover the copayments and deductibles for Medicare services.

With Cost Share Plans people can join even if they solely have Medicare Part B. One can join anytime the Medicare Cost Plan is accepting new members, and a member can leave anytime and return to original Medicare. Open enrollment falls under the same dates as Medicare Open enrollment each year.

When reviewing eligibility, a facility will find the Medicare response showing as Medicare Part C, and may assume services are limited like many other Medicare Advantage Plans. During your verification steps is when you will find the member has a Medicare Cost Plan. Be sure to follow your facility insurance verification process for details.