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The HCBS Waiver currently has 28 services [1] and there is a spending cap based on the individuals needs. However, services must be "medically necessary". Individuals that meet the following criteria are eligible to receive services under the Home and Community Based Services Waiver: Be under 65 years of age; Be a Florida resident
As of 2014, 26 states have contracts with MCOs to deliver long-term care for the elderly and individuals with disabilities. [2] There are two main forms of Medicaid managed care, "risk-based MCOs" and "primary care case management (PCCM)." [3] Managed care delivery systems grew rapidly in the Medicaid program during the 1990s.
The ICF/MR Program began in 1971 when legislation began federal funding for ICFs/MR as an optional, beneficial Medicaid service. Authorization for ICF/MR services were seen at the congressional level as an option under the state plan Medicaid services. This allowed states to receive matching federal funds for these institutional services. [2]
Under an HCBS waiver, states can use Medicaid funds to provide a broad array of non-medical services (excluding room and board) not otherwise covered by Medicaid, if those services allow recipients to receive care in community and residential settings as an alternative to institutionalization.
Of the 1.9 million people in Florida who lost Medicaid coverage, according to KFF, patient advocates estimate that thousands of disabled people like Eakin have been affected.
2.6 million were in the "coverage gap" due to the 19 states that chose not to expand the Medicaid program under the ACA/Obamacare, meaning their income was above the Medicaid eligibility limit but below the threshold for subsidies on the ACA exchanges (~44% to 100% of the federal poverty level or FPL); 5.4 million were undocumented immigrants;
Florida's Medicaid call center is experiencing long wait times and high rates of disconnection that could be preventing families from renewing or accessing healthcare coverage, according to a ...
In addition, dual-eligibles may choose a type of MA plan called a dual-eligible special needs plan (D-SNP), which is designed to target the needs of this population. For Medicaid benefits, beneficiaries generally enroll in their state's Medicaid FFS program or a Medicaid managed care plan administered by an MCO under contract with the state.
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