Health/Senior

Conference call trainings were held for consumer and providers on May 6 and legal services and legal aid programs on May 13, 2004. If you would like a copy of the materials referenced in the trainings, or have any questions about the new procedures, email Miriam Harmatz.

Hernandez et al. v. Medows, Secretary of AHCA, a class action challenging the Medicaid agency’s failure to provide recipients with written notice and hearing rights when coverage for a prescription drug was denied, settled in March 2003, and a final order was entered in May. Click here for settlement agreement. If Medicaid is currently denying coverage for one or more of your prescriptions, you should contact your local legal service program for assistance. The legal services directory is located here.

As of May 14, 2004, the Medicaid agency and Medicaid HMOs are required to provide recipients with a written notice whenever their prescription drugs are not covered. The notice/pamphlet will be issued by the pharmacist and will explain why the drug was not covered; what the beneficiary and doctor may need to do to get coverage; how to access consumer help through a new ombudsman’s office; how and when to request a fair hearing if the problem is not resolved by the ombudsman within 3 business days; and the circumstances under which an immediate 3 days supply must be given by the pharmacy. English and Spanish copies of the pamphlet/notice are available.

Although most drugs should be covered and the ombudsman’s office should be able to resolve most problems, legal services and legal aid offices may see clients who are confused by the new procedures or whose problems are still not resolved by the ombudsman. A client question and answer handout in English, Spanish and Haitian Creole are available. Suggested forms for intake, interview and client self help letter can be found by clicking client intake forms.

Conference call trainings were held for consumer and providers on May 6 and legal services and legal aid programs on May 13, 2004. If you would like a copy of the materials referenced in the trainings, or have any questions about the new procedures, email Miriam Harmatz.

The Florida Medicaid Program is currently operating a number of waiver programs for the aged and disabled population. Often application procedures, eligibility criteria and waiting list policies for these programs are a well-kept secret! Florida Legal Services is working with local programs to gather information on how these waivers are functioning in their home counties and to pursue advocacy strategies to make these services more accessible for clients. FLS is working in conjunction with Southern Legal Counsel, Inc. to provide waiver training and related materials for local field programs and other advocacy groups. If you want more information about training, please contact Miriam Harmatz or Anne Swerlick with Florida Legal Services.

The Florida Medicaid program is a jointly funded federal state program which provides medical assistance to certain categories of low income people. The federal government pays 59% of the cost of the program and the state of Florida pays the remaining 41% . The U.S. Health and Human Services, Centers for Medicare and Medicaid Services (CMS) administers the program on the federal level and the State of Florida Agency for Health Care Administration (AHCA) administers the program at the state level. AHCA contracts with the Department of Children and Families (DCF) to perform Medicaid eligibility determinations. Listed below are links to the 2003 income and resource limits for Florida Medicaid coverage groups.

CMS interpretive guidelines: State Medicaid Manual is available on the CMS website, (http://www.cms.gov). "Dear State Medicaid Director" letters are also available on the CMS website.

State Medicaid Manual available from HCFA's website (http://www.cms.gov). Excerpts are also reprinted in the CCH Medicare and Medicaid Guide; "Dear State Medicaid Director" letters available from HCFA's website.

Regulations: ''65A-1.701-1.720, F.A.C. (DCF rules on Medicaid eligibility); 59G-4, F.A.C. (AHCA rules on Medicaid services); 59G-8 F.A.C. (AHCA rules on Medicaid managed care)

DCF Policies: Integrated Public Assistance Policy Manual, 165-22. It is available by clicking below:

Florida KidCare Program - The Florida KidCare program provides health coverage for children and youth through age 18. It is comprised of the following components: children’s Medicaid, Medikids, the Florida Healthy Kids Corporation and the Children’s Medical Services network. Children in households with income at or below 200% of the federal poverty level are eligible. All KidCare components, except Medicaid are funded under Title XXI of the Social Security Act. The federal government pays 69% of the cost of the program. However funding and program enrollment are capped, except for the Medicaid component. The following is a list of sources of law for the Florida KidCare program:

Statutes: § § 409.810-409.820, Florida Statutes (2002) (Florida Kidcare Act) ; § 624.91, Florida Statutes (2002) (Florida Healthy Kids Corporation) ; Chapter 391, Florida Statutes (2002) (Children’s Medical Services)

The Florida Agency for Health Care Administration (AHCA) AHCA is the single state agency which administers the Medicaid program. Almost all of the administrative rules governing the Florida Medicaid program have been repealed and instead, provider handbooks for each service have been incorporated into the relevant rule by reference. Most of the handbooks and their updates are included on the AHCA web site. In addition, this web site includes data and other information on Florida's Medicaid managed care program.

KidCare KidCare, which is Florida's Child Health Insurance Program (CHIP), consists of several different programs including Medicaid and Florida Healthy Kids. This web site provides a description of the different program components, including eligibility requirements and provides links to the individual program websites. In addition, it includes a copy of the KidCare application which can be downloaded and printed for use.

Department of Elder Affairs This web site includes information on Elder Helplines, the SHINE program, Area Agencies on Aging, as well as a copy of the most recent publication of the Elder Update.

Department of Children and Families This site includes SSI-Related Programs Fact Sheets which describe various Medicaid programs for the elderly and people with disabilities.

The National Health Law Program This web site provides information and analysis on issues relating to Medicaid, immigrant health, managed care, child health programs, as well as articles on new developments in poverty health law. It also includes a federal register webpage providing a condensed version of federal register excerpts relating to health issues, as well as links to a wide variety of other useful Internet locations.

Center for Medicare Advocacy The Center provides legal advice, self-help materials, and representation to elders and people with disabilities who are unfairly denied Medicare coverage. The web site has information on Medicare topics including Medicare+choice, Skilled Nursing Facilities, MediGap, Home Health, Hospice Care, and Medicare Reform.

Families USA This site includes a Medicaid and Managed Care Clearinghouse, as well as news on national legislative and administrative developments.

Children's Defense Fund This site's "Healthy Start" section contains dozens of useful articles and statistics on children's health, including information about uninsured children and the Children's Health Insurance Program.

American Academy of Pediatrics This pediatrician organization's "Advocacy" section contains links to materials on the organization's federal and state advocacy efforts, its current campaigns and programs, and its position papers and policy statements. Its "Research" section contains very useful reports from its Division of Health Policy Research.

The Henry J. Kaiser Family Foundation This web site offers information on health care issues affecting the poor, including information about the Medicaid program. From the home page, go to the Medicaid option on the navigation bar. This link leads to a page devoted to the Medicaid program, which contains a primer on the program.

Centers for Medicare and Medicaid Services formerly the Health Care Financing Administration The Centers for Medicare and Medicaid Services is the federal agency that administers the Medicare, Medicaid and Child Health Insurance programs. If you seek information about any of these programs, this is a good place to start.

National Maternal and Child Health Clearinghouse The Clearinghouse is funded by the Health Resources and Services and Administration (HRSA), Maternal and Child Bureau (MCHB), a branch of the U.S. Department of Health and Human Services (HHS). It contains numerous full-text publications regarding maternal and child health, and over five hundred items in the catalog available for ordering.

Consumer Health/Agency for Health Care Policy and Research This government agency provides useful consumer materials on its website, including information on health insurance choices, how to choose a health plan, insurance for children, Medline access, personal and child health guides, a guide to quality health care, and consumer versions of clinical practice guidelines listed by condition.

Groups Home	For more advocate information visit: www.fladvocate.org For more client-related information visit: www.floridalawhelp.org Legal services/Legal Aid attorneys and paralegals represent low income and elderly Floridians on a range of health and elder law issues. This includes individuals denied eligibility or terminated from the Medicaid program or the KidCare program, individuals having difficulties accessing services under the Medicaid or Medicare programs, individuals experiencing problems with their health maintenance organization (HMO), nursing home residents at risk of eviction and other related areas. Legal services offices in Florida assist low-income clients with these and other legal problems without charge for their services. *Medicaid Prescribed Drug Program* As of May 14, 2004, the Medicaid agency and Medicaid HMOs are required to provide recipients with a written notice whenever their prescription drugs are not covered. The notice/pamphlet will be issued by the pharmacist and will explain why the drug was not covered; what the beneficiary and doctor may need to do to get coverage; how to access consumer help through a new ombudsman’s office; how and when to request a fair hearing if the problem is not resolved by the ombudsman within 3 business days; and the circumstances under which an immediate 3 days supply must be given by the pharmacy. English and Spanish copies of the pamphlet/notice are available. Although most drugs should be covered and the ombudsman’s office should be able to resolve most problems, legal services and legal aid offices may see clients who are confused by the new procedures or whose problems are still not resolved by the ombudsman. A client question and answer handout in English, Spanish and Haitian Creole are available. Suggested forms for intake, interview and client self help letter can be found by clicking client intake forms. Conference call trainings were held for consumer and providers on May 6 and legal services and legal aid programs on May 13, 2004. If you would like a copy of the materials referenced in the trainings, or have any questions about the new procedures, email Miriam Harmatz. Hernandez et al. v. Medows, Secretary of AHCA, a class action challenging the Medicaid agency’s failure to provide recipients with written notice and hearing rights when coverage for a prescription drug was denied, settled in March 2003, and a final order was entered in May. Click here for settlement agreement. If Medicaid is currently denying coverage for one or more of your prescriptions, you should contact your local legal service program for assistance. The legal services directory is located here. As of May 14, 2004, the Medicaid agency and Medicaid HMOs are required to provide recipients with a written notice whenever their prescription drugs are not covered. The notice/pamphlet will be issued by the pharmacist and will explain why the drug was not covered; what the beneficiary and doctor may need to do to get coverage; how to access consumer help through a new ombudsman’s office; how and when to request a fair hearing if the problem is not resolved by the ombudsman within 3 business days; and the circumstances under which an immediate 3 days supply must be given by the pharmacy. English and Spanish copies of the pamphlet/notice are available. Although most drugs should be covered and the ombudsman’s office should be able to resolve most problems, legal services and legal aid offices may see clients who are confused by the new procedures or whose problems are still not resolved by the ombudsman. A client question and answer handout in English, Spanish and Haitian Creole are available. Suggested forms for intake, interview and client self help letter can be found by clicking client intake forms. Conference call trainings were held for consumer and providers on May 6 and legal services and legal aid programs on May 13, 2004. If you would like a copy of the materials referenced in the trainings, or have any questions about the new procedures, email Miriam Harmatz. *Medicaid Waivers* The Florida Medicaid Program is currently operating a number of waiver programs for the aged and disabled population. Often application procedures, eligibility criteria and waiting list policies for these programs are a well-kept secret! Florida Legal Services is working with local programs to gather information on how these waivers are functioning in their home counties and to pursue advocacy strategies to make these services more accessible for clients. FLS is working in conjunction with Southern Legal Counsel, Inc. to provide waiver training and related materials for local field programs and other advocacy groups. If you want more information about training, please contact Miriam Harmatz or Anne Swerlick with Florida Legal Services. Sources of law for the Medicaid program: The Florida Medicaid program is a jointly funded federal state program which provides medical assistance to certain categories of low income people. The federal government pays 59% of the cost of the program and the state of Florida pays the remaining 41% . The U.S. Health and Human Services, Centers for Medicare and Medicaid Services (CMS) administers the program on the federal level and the State of Florida Agency for Health Care Administration (AHCA) administers the program at the state level. AHCA contracts with the Department of Children and Families (DCF) to perform Medicaid eligibility determinations. Listed below are links to the 2003 income and resource limits for Florida Medicaid coverage groups. Federal Law: Statutes: 42 U.S.C. '' 1396 - 1396u Regulations: 42 C.F.R. Parts 430- 455 CMS interpretive guidelines: State Medicaid Manual is available on the CMS website, (http://www.cms.gov). "Dear State Medicaid Director" letters are also available on the CMS website. State Medicaid Manual available from HCFA's website (http://www.cms.gov). Excerpts are also reprinted in the CCH Medicare and Medicaid Guide; "Dear State Medicaid Director" letters available from HCFA's website. State Law: Statutes: '' 409.901-.9205, Florida Statutes (2002). Regulations: ''65A-1.701-1.720, F.A.C. (DCF rules on Medicaid eligibility); 59G-4, F.A.C. (AHCA rules on Medicaid services); 59G-8 F.A.C. (AHCA rules on Medicaid managed care) AHCA Policies: Medicaid Provider Handbooks describing policies for a range of Medicaid services are available from ACHA's website (www.fdhc.state.fl.us); Model contract between AHCA and Florida's Medicaid HMOs is available from AHCA's website. DCF Policies: Integrated Public Assistance Policy Manual, 165-22. It is available by clicking below: http://www5.myflorida.com/cf_web/myflorida2/healthhuman/publications/esspolicymanual Florida KidCare Program - The Florida KidCare program provides health coverage for children and youth through age 18. It is comprised of the following components: children’s Medicaid, Medikids, the Florida Healthy Kids Corporation and the Children’s Medical Services network. Children in households with income at or below 200% of the federal poverty level are eligible. All KidCare components, except Medicaid are funded under Title XXI of the Social Security Act. The federal government pays 69% of the cost of the program. However funding and program enrollment are capped, except for the Medicaid component. The following is a list of sources of law for the Florida KidCare program: Federal Law: Statutes: 42 U.S.C. §§ 1397aa-1397jj Regulations: 42 C.F.R. Part 457 CMS Letters to State Officials: Available at the CMS website at www.cms.gov State Law: Statutes: § § 409.810-409.820, Florida Statutes (2002) (Florida Kidcare Act) ; § 624.91, Florida Statutes (2002) (Florida Healthy Kids Corporation) ; Chapter 391, Florida Statutes (2002) (Children’s Medical Services) Useful Websites for Health/Senior Advocates Florida sites: The Florida Agency for Health Care Administration (AHCA) AHCA is the single state agency which administers the Medicaid program. Almost all of the administrative rules governing the Florida Medicaid program have been repealed and instead, provider handbooks for each service have been incorporated into the relevant rule by reference. Most of the handbooks and their updates are included on the AHCA web site. In addition, this web site includes data and other information on Florida's Medicaid managed care program. KidCare KidCare, which is Florida's Child Health Insurance Program (CHIP), consists of several different programs including Medicaid and Florida Healthy Kids. This web site provides a description of the different program components, including eligibility requirements and provides links to the individual program websites. In addition, it includes a copy of the KidCare application which can be downloaded and printed for use. Department of Elder Affairs This web site includes information on Elder Helplines, the SHINE program, Area Agencies on Aging, as well as a copy of the most recent publication of the Elder Update. Department of Children and Families This site includes SSI-Related Programs Fact Sheets which describe various Medicaid programs for the elderly and people with disabilities. National Organizations: The National Health Law Program This web site provides information and analysis on issues relating to Medicaid, immigrant health, managed care, child health programs, as well as articles on new developments in poverty health law. It also includes a federal register webpage providing a condensed version of federal register excerpts relating to health issues, as well as links to a wide variety of other useful Internet locations. National Senior Citizens Law Center This web site focuses on issues affecting low income elderly individuals. Center for Medicare Advocacy The Center provides legal advice, self-help materials, and representation to elders and people with disabilities who are unfairly denied Medicare coverage. The web site has information on Medicare topics including Medicare+choice, Skilled Nursing Facilities, MediGap, Home Health, Hospice Care, and Medicare Reform. Families USA This site includes a Medicaid and Managed Care Clearinghouse, as well as news on national legislative and administrative developments. Children's Defense Fund This site's "Healthy Start" section contains dozens of useful articles and statistics on children's health, including information about uninsured children and the Children's Health Insurance Program. American Academy of Pediatrics This pediatrician organization's "Advocacy" section contains links to materials on the organization's federal and state advocacy efforts, its current campaigns and programs, and its position papers and policy statements. Its "Research" section contains very useful reports from its Division of Health Policy Research. The Henry J. Kaiser Family Foundation This web site offers information on health care issues affecting the poor, including information about the Medicaid program. From the home page, go to the Medicaid option on the navigation bar. This link leads to a page devoted to the Medicaid program, which contains a primer on the program. Federal Government sites: Centers for Medicare and Medicaid Services formerly the Health Care Financing Administration The Centers for Medicare and Medicaid Services is the federal agency that administers the Medicare, Medicaid and Child Health Insurance programs. If you seek information about any of these programs, this is a good place to start. National Maternal and Child Health Clearinghouse The Clearinghouse is funded by the Health Resources and Services and Administration (HRSA), Maternal and Child Bureau (MCHB), a branch of the U.S. Department of Health and Human Services (HHS). It contains numerous full-text publications regarding maternal and child health, and over five hundred items in the catalog available for ordering. Consumer Health/Agency for Health Care Policy and Research This government agency provides useful consumer materials on its website, including information on health insurance choices, how to choose a health plan, insurance for children, Medline access, personal and child health guides, a guide to quality health care, and consumer versions of clinical practice guidelines listed by condition. Health/Senior Pamphlets The pamphlets are available by visiting http://www.FloridaLawHelp.org.
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