Florida Medicaid RECIPIENTS: Know Your Rights During Covid-19 Emergency

Florida Medicaid Recipients:
​Know Your Rights During Covid-19 Emergency

April 2, 2020/Updated June 28, 2020

 Q:  Can I be terminated from Medicaid?  We just inherited $10,000 from my father.
 
A:  No. The only bases for termination during the state of emergency are if you move out of state or voluntarily withdraw. 
 
Q:  I was on Medicaid for about a year but it was terminated on March 20, 2020.  Can I get back on? 
 
A:  Yes.  Anyone who had their Medicaid terminated on or after March 18 should be reinstated and you will be covered for all of March.  If you have a problem or question, contact Florida Health Justice Project here, 
 
Q:  I have been receiving Medicaid for several years and my recertification period is coming up in May.  Will I still need to recertify?
 
A: No.  DCF has implemented a six-month recertification extension for individuals and families scheduled to recertify for Medicaid (as well as food stamps and TANF) in April or May 2020.
 
Q:  I get a number of prescription drugs and usually I can only get a supply for 30 days.  I am nervous about going to the drug store during the epidemic.  Can I get a longer prescription?
 
A:  Yes.  Medicaid and Medicaid managed care plans must provide coverage for 90 day supplies of all your prescription drugs (except controlled substances), but you have to request the 90 day supply from the pharmacy.
 
Q:  I just enrolled in a Medicaid managed care plan and the member handbook mentions various co-payments.  Will those apply now?
 
A:  No.  There cannot be co-payments charged by Medicaid managed care plans or regular Medicaid during the emergency.  
 
 Q:  My Medicaid MCO has sent me a notice denying coverage for the full amount of home health care my doctor prescribed.  The notice describes how I need to first appeal to the MCO.  Is that still the case?
 
A:  No.  You can file your request for a fair hearing directly to the Medicaid Agency by emailing MedicaidHearingUnit@ahca.myflorida.com; or calling 1-877-254-1055. 
 
Q:  How long will it be before I can get a hearing decision?
 
A:  The hearing decision is still due within 90 days of the date of your hearing request.  
 
Q:  I had heard that hearings can be postponed during the emergency.  Is that correct?
 
A:  Hearings can only be postponed if you are still getting the benefit pending the outcome of the hearing.  In other words, if your child has been getting 3 hours of home health care a day and you got a notice saying it would be reduced to 1 hour/day, and you appealed within 10 days of the notice (which keeps the benefit going through the appeal), then the hearing can be postponed. 
 
If you are appealing the denial of something you are not currently getting and were prescribed (including the amount of services in the prescription), the hearing cannot be delayed. 
 
Q:  My mother has been in the hospital with COVID-19 for almost 3 weeks, and we are concerned that her Medicaid managed care plan has a limit of 45 days of hospitalization.  What will happen if she needs to be in the hospital for more than 45 days?
 
A:  Medicaid, including Medicaid managed care plans cannot apply regular limits on services including hospitalization, as well as other services, for patients diagnosed with COVID-19.  
 
Q :  My parents receives home health services on an ongoing basis, but the services are sometimes interrupted and delayed while we wait for the prior authorization forms between our doctor and the plan to go back and forth.  Is the prior authorization process going to continue during the emergency?
 
A:  Yes. With the exception of behavioral health services prior authorization requirements, which had been waived (See: AHCA Florida Medicaid Healthcare Alert ,March 16, 2020) prior authorization requirements were reinstated for all patients on June 19, 2020. (See:  AHCA Florida Medicaid Healthcare Alert June 12, 2020.)
 
 Q:   What should I do if I am having a problem with my Medicaid eligibility or services? 
 
A:  You can contact Florida Health Justice Project at this link; please mention in the message that you have a COVID question or concern. https://www.floridahealthstories.org/contact
 

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Visit our website for more information and resources related to Florida’s health justice challenges during the Covid-19 emergency. ​

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