1) State: Florida
2) Own or Federal Exchange? Federal Exchange
Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/florida.html
3) Medicaid Expansion? No
Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/florida.html
4) What kind of coverage is available for mental health/substance abuse treatment through
Medicaid?
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The Florida Department of Children and Families Mental Health Program Office is responsible
for planning, managing and evaluating a statewide program of mental health services and
supports, including community programs, crisis services, state residential treatment facilities,
and children’s mental health services. The public mental health system is funded by federal
block grant dollars and the Florida Legislature.
Though the state directly operates some of its mental health treatment facilities, Florida's
community mental health system is completely privatized. Public funds are contracted through
local Mental Health Program Offices, mostly with non-profit local Community Mental Health
Centers. People who need services get them by going to those providers directly - the state
mental health program offices do not provide services.
There are 20 local Substance Abuse and Mental Health Program Offices in Florida. DCF's local
service areas match boundaries with Judicial Circuits. Some local offices cover more than one
Judicial Circuit. Each year, the Florida Legislature appropriates money to the Central Mental
Health Program Office. This money is then allocated to each Circuit. Circuit offices then
contract with local community-based providers, agencies, and facilities that serve people in
crisis, with serious mental illnesses, and / or substance use disorders.
It is the local offices that actually manage and oversee the public mental health system. Within
each Circuit office, there are people responsible for monitoring and assisting with local adult
and / or children's mental health services and supports.
Medicaid reimbursement is available for mental and behavioral health services covered under
various service categories: physician's services, inpatient and outpatient hospital services,
licensed practitioner's services, clinics, rehabilitative services, inpatient psychiatric hospital
services for individuals under age 21, as well as, prescription drugs. Examples of Services in
these categories include: Counseling, therapy, medication management, psychiatrist's services,
licensed clinical social work services, peer supports, and substance abuse treatment.
Individuals may receive services in their homes, other residences, in schools, or medical
institutions, if necessary. While states have the option to cover some of these services, EPSDT
requires that children receive all medically necessary services, including mental health services.
In addition to State Plan services, states may offer mental health benefits through Mental
Health Parity and Addiction Equity Act.
Medicaid Alternative Benefit Packages (ABPs) are required to comport with the Mental Health
Parity and Addiction Equity Act (MHPAEA). The enactment of the Affordable Care Act extended
MHPAEA application in Medicaid to all coverage of MH/SUD services offered in Alternative
Benefit Plans (ABPs), in addition to its application to the Children Health Insurance Plan (CHIP)
program, and state Medicaid plan services offered through managed care organizations.
Source: http://www.myflfamilies.com/service-programs/mental-health/adult-mental-health
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Mental-HealthServices-.html
5) Does the state allow the court to order treatment and still have it paid by Medicaid?
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The court can order treatment and have it paid by Medicaid if the services are covered by
Medicaid (shown in the question above).
6) Are there restrictions related to treatment providers for probationers, substance abuse, or mental
health treatment? Will only certain providers be covered?
 There are limits on the length and frequency of counseling and consultation.
The following is a listing of covered services: (see the website for attached health plan specific
benefit grid for details regarding benefit limitations)
• Inpatient Hospital Services (Mental Health Diagnosis)
• Outpatient Hospital Services (Mental Health Diagnosis)
• Physician Services (Mental Health Diagnosis)
o Community Mental Health Services Treatment Plan Development and Modification
o Assessment Services o Medical and Psychiatric Services
o Behavioral Health Therapy Services
o Community Support and Rehabilitation Services
o Therapeutic Behavioral On-Site Services for Children and Adolescents (TBOS)
o Services for Children Ages 0-5 Years (Behavioral Health Day Services and TBOS)
o Crisis Intervention Mental Health Services and Post-Stabilization Care Services
o Substance Abuse Services by Referral (available through fee-for- services only)
• Mental Health Targeted Case Management
Source: http://www.compcare.com/ProvManuals/FL/FLMedicaidSupplementalToProviderManual-Medica.pdf
7) Is there coverage for residential substance abuse treatment? What are the parameters?
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Residential Level 1: These are licensed services that provide structured, live-in, non-hospital
settings with 24-hour supervision daily. There is a nurse on duty in these facilities at all times.
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For adult mental health, these services include two different kinds of programs: group homes
and short-term residential treatment services. Group homes are for residents who may
require longer lengths of stay. These facilities offer nursing supervision provided by, at a
minimum, licensed practical nurses, 24 hours a day, seven days per week.
Residential Level 2: These are licensed, structured rehabilitation-oriented group facilities that
have 24-hour a day, seven days per week supervision. Level 2 facilities are for persons who
have significant deficits in independent living skills and need extensive support and
supervision.
Short-term Residential Treatment: These individualized, acute, and immediately sub-acute
care services provide intensive mental health residential and rehabilitative services 24 hours a
day, seven days per week. These services must meet the needs of individuals who are
experiencing an acute or immediately sub-acute crisis and who, in the absence of a suitable
alternative, would require hospitalization. SRT services provide intensive residential treatment
for individuals in need of acute care for up to 120 days.
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Inpatient substance abuse treatment is provided in hospitals licensed under Chapter 395, F.S., as
general hospitals and psychiatric specialty hospitals. They are designed to provide intensive
treatment to persons exhibiting violent behaviors, suicidal behaviors and other severe
disturbances due to substance abuse or mental illness.
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There is coverage for residential treatment through Medicaid and the Marketplace for a limited
period of time.
Source: http://myflfamilies.com/service-programs/mental-health/treatment
8) What is the process and what are the regulations for treatment providers to be able to participate?
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Providers must be licensed or certified to practice in the state of Florida. They also must be
Florida Medicaid Certified to receive reimbursements.
Depending on which network the provider chooses to be in, a selection decision is based not
only on the practitioner’s qualifications but also on the network and member needs. The
Provider Selection Committee reviews practitioners/providers requesting inclusion in the
network. This committee also reviews all practitioners for re-credentialing based on NCQA
requirements. Decisions are based on network needs, member complaints peer review issues,
and any site visits or record reviews.
Source: http://www.compcare.com/ProvManuals/FL/FL-MedicaidSupplementalToProviderManualMedica.pdf
9) Is dental care covered?
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Dental care is an option in the Marketplace, but is not included in the basic plan (except for
children). Up to $3,000 is provided for dental care due to accidental injury NOT related to
chewing/biting
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Case managers do an assessment of the need for medical and dental services and referrals are
made to physicians or dentists in the community who accept Medicaid. People who do not have
Medicaid are referred to whatever medical or dental services are available locally. These
resources may include Regional Workforce Board One-Stop Centers and public health
departments, medical societies, individual physicians, and hospitals. The Florida Department of
Children and Families pays for medical and dental care for individuals living in state mental
health residential treatment facilities.
Source: http://myflfamilies.com/service-programs/mental-health/treatment