Resources

In Florida, the integration of care for individuals eligible for both Medicare and Medicaid—known as dual-eligible beneficiaries—has evolved through various initiatives aimed at improving care coordination and access. Historically, dual-eligible individuals in Florida navigated separate Medicare and Medicaid systems, leading to fragmented care and administrative challenges. To address these issues, the state implemented the Medicaid Managed Care Program, which includes Medicare Dual Eligible Special Needs Plans (D-SNPs). These plans are specifically designed to coordinate Medicare and Medicaid benefits, offering additional services beyond Original Medicare, such as transportation to medical appointments and routine vision exams.

ahca.myflorida.com

The current landscape in Florida offers several resources to support dual-eligible consumers:

1. Community HealthChoices (CHC):

• • Link: Florida Community HealthChoices
  • Description: This program provides Medicaid managed care for Florida residents who are dual-eligible or have long-term care needs. It offers coordinated care through Managed Care Organizations (MCOs) that integrate physical health, behavioral health, and long-term services and supports (LTSS). It ensures dual-eligible individuals can access essential services, including home- and community-based services (HCBS).
  • Key Strength: Focuses on person-centered care and enhancing access to both medical and non-medical services for those who need them the most.

2. Medicare Dual Eligible Special Needs Plans (D-SNPs):

• • Link: Medicare Dual Eligible Special Needs Plans – AHCA
  • Description: These plans are specifically designed for individuals eligible for both Medicare and Medicaid. D-SNPs coordinate Medicare and Medicaid benefits, offering additional services such as transportation, vision care, and wellness benefits. These plans help simplify care and make it easier for dual-eligible individuals to access the healthcare services they need.
  • Key Strength: Provides enhanced benefits beyond Original Medicare and ensures that care is well-coordinated between Medicare and Medicaid.

3. Florida Department of Elder Affairs (DOEA):

• • Link: Florida Department of Elder Affairs
  • Description: The DOEA offers programs and resources that help seniors, including those who are dual-eligible, to navigate Medicaid, Medicare, and long-term care options. They provide a wealth of information on aging services, healthcare assistance, and community support services across Florida.
  • Key Strength: Serves as a central resource for seniors seeking information about health benefits, long-term care services, and aging-related programs.

4. Florida Medicaid Managed Care Program:

• • Link: Florida Medicaid Managed Care Program
  • Description: This program integrates Medicaid services for eligible individuals, including those who are dual-eligible, to ensure coordinated care. The Medicaid Managed Medical Assistance (MMA) and Long-Term Care (LTC) plans provide health coverage and support for long-term services.
  • Key Strength: Focuses on improving the quality of care for Medicaid beneficiaries by coordinating health services through Managed Care Organizations (MCOs).

5. Florida Health Justice Project:

• • Link: Florida Health Justice Project
  • Description: A nonprofit organization that advocates for health equity and provides resources to help dual-eligible individuals understand their rights and access health services. They work on policies that protect and improve access to Medicaid and Medicare, particularly for vulnerable populations.
  • Key Strength: Advocacy for health equity and direct assistance with navigating healthcare access and legal issues.

6. Florida Senior Legal Helpline:

• • Link: Florida Senior Legal Helpline
  • Description: Operated by the Florida Department of Elder Affairs, the Senior Legal Helpline offers free legal services to seniors, including dual-eligible individuals. They provide support on issues such as Medicaid and Medicare eligibility, benefits, and dispute resolution.
  • Key Strength: Helps seniors navigate complex legal and healthcare issues with a focus on protecting their rights.

7. Area Agencies on Aging (AAAs):

• • Link: Florida Area Agencies on Aging
  • Description: Florida has 11 Area Agencies on Aging that offer support and resources to seniors and dual-eligible individuals. These agencies provide information about benefits counseling, long-term care options, and other community services that assist with navigating healthcare and aging needs.
  • Key Strength: Localized support with tailored services to help individuals access healthcare, community services, and long-term care resources.

8. Florida Medicaid Fraud Control Unit (MFCU):

• • Link: Florida Medicaid Fraud Control Unit
  • Description: The MFCU investigates and prosecutes cases of Medicaid fraud and abuse, ensuring that dual-eligible individuals receive the care and services they are entitled to. The unit also protects vulnerable populations from exploitation and neglect within the Medicaid system.
  • Key Strength: Protects dual-eligible individuals by ensuring that Medicaid services are delivered honestly and fairly.

9. Florida Health Finder:

• • Link: Florida Health Finder
  • Description: A resource provided by the Florida Agency for Health Care Administration, Florida Health Finder helps consumers find healthcare providers and services across the state. It also includes detailed quality ratings for healthcare facilities and information on patient rights, enabling dual-eligible individuals to make informed choices about their care.
  • Key Strength: Provides up-to-date information on healthcare provider quality and helps individuals make decisions based on reliable data.

10. Florida Department of Children and Families (DCF):

• • Link: Florida Department of Children and Families
  • Description: DCF is responsible for administering Medicaid in Florida. They offer resources on eligibility, benefits, and enrollment for individuals who are dual-eligible, including access to health coverage and services.
  • Key Strength: Provides critical access to Medicaid services and assistance for dual-eligible individuals throughout Florida, helping them enroll in and manage their benefits.

These resources play a vital role in helping Florida’s dual-eligible population access comprehensive healthcare services, legal support, and community-based assistance to meet their diverse needs.