Page 2 - Florida Long-Term Care Medicaid Post Approval Client Guide

Family First Firm • Florida Medicaid Post-Approval Guide

TABLE OF CONTENTS

Table of Contents.................................................................................................................... 2
1. Enrollment Advisement and Guidance................................................................................. 4

Understanding the SMMC Program....................................................................................... 4
Choosing Your Plan............................................................................................................... 4
2. Understanding AHCA and Provider Correspondence........................................................... 5

Key Agencies......................................................................................................................... 5
3. Understanding Notices of Case Action (NOCA).................................................................. 6
Types of Notices.................................................................................................................... 6
Key Elements of a NOCA...................................................................................................... 6
Your Appeal Rights................................................................................................................ 6

4. Guidance on Changing Plans.............................................................................................. 7
When You Can Change Plans............................................................................................... 7
How to Change Plans........................................................................................................... 7

5. Waiver vs. ICP: Billing and Patient Liability.......................................................................... 8
ICP (Nursing Home Medicaid) ............................................................................................. 8
LTC Waiver (Home or Assisted Living) .................................................................................. 8
6. Information Regarding Supplemental Insurance................................................................. 9
6a. Waiver Recipients (Home Care/ALF).............................................................................. 9

6b. In-Home Care Recipients............................................................................................... 9
6c. Assisted Living Facility (ALF) Residents........................................................................... 9
7. QIT Instructions and Maintaining Financial Eligibility......................................................... 10

Monthly QIT Requirements.................................................................................................. 10
Funding Rules..................................................................................................................... 10
Disbursing QIT Funds.......................................................................................................... 10
Other Financial Eligibility Reminders.................................................................................. 10
8. Medicare Overview – Keeping Your Coverage.................................................................... 11

Medicare and Medicaid: How They Work Together............................................................. 11
Maintaining Your Medicare Parts A and B........................................................................... 11
Medicare Part D (Prescription Drug Coverage).................................................................. 11

9. Recertification Information................................................................................................ 12
What to Expect................................................................................................................... 12
Your Responsibilities............................................................................................................ 12

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