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2018 New CPT codes

00731  Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified ...

ELIGIBILITY FOR MEDICAID SERVICES



The Department of Children and Families and the Social Security Administration determine Medicaid recipient eligibility. Two basic groups of people are eligible for Medicaid: 1) low income children and families and 2) the aged, blind and disabled. Within these two groups, there are several categories of eligibility. In addition to qualifying under one of these two basic groups, an eligible Medicaid recipient must meet income and asset limits. These vary by category.

Following are the categories for Medicaid eligibility in Florida:

1) Families and Children

Emergency Medicaid for Aliens reimburses emergency services provided to aliens who meet all Medicaid eligibility requirements except for citizenship or alien status.

Family Planning Waiver extends eligibility for family planning services for 24 months to women who have had a Medicaid-financed delivery or other pregnancy-related service within two years before losing Medicaid eligibility.

Foster Care, Adoption Subsidy and Emergency Shelter include dependent children in the care and control of the state and children with special medical needs whose adoption was supported by the state or a private adoption agency.

Low Income Families include single-parent families and families with a disabled or unemployed parent.

Medicaid Expansion Designated by SOBRA (MEDS) includes children up to age 19 and pregnant women.

Medicaid for Teens includes children up to age 19 who were born before October 1, 1983, and have incomes at or 100 percent below federal poverty level.

Medically Needy includes individuals whose income is too high to qualify for other Medicaid programs but who have large monthly medical bills. Their Medicaid eligibility is redetermined every month.

Mary Brogan Breast and Cervical Cancer Program includes women who are screened and diagnosed with breast or cervical cancer through the Florida Breast and Cervical Cancer Early Detection Program administered by the Department of Health. Women entitled through this program must have income at or below 200 percent of the federal poverty level and will receive all Medicaid benefits.

Public Medical Assistance (PMA) includes children in intact families and children born after
September 30, 1983, not living with relatives.

2) Aged, Blind and Disabled (SSI-Related)

Supplemental Security Income (SSI) eligibility is determined by the Social Security Administration. Individuals who receive SSI in Florida are automatically eligible for full Medicaid benefits. To be eligible for SSI, an individual must be age 65 or older or totally and permanently disabled, and meet the income and asset limits.

Medicaid for the Aged and Disabled (MEDS-AD) covers individuals who are age 65 or older or totally and permanently disabled, have income less than 90 percent of the Federal Poverty Level, and meet the asset limit.

Institutional Care Program (ICP) includes individuals requiring long-term institutional care or hospice.

Medicaid Waiver Assistance (MWA) covers individuals in a special income group who are participating in home and community-based waiver programs.

Qualified Medicare Beneficiaries (QMB) entitles individuals who have income not exceeding 100 percent of the Federal Poverty Level and who are entitled to Medicare Part A and who are not otherwise eligible for Medicaid to receive Medicaid payment of their Medicare premiums, deductibles, and coinsurances.

Special (Specified) Low-Income Medicare Beneficiaries (SLMB) entitles individuals who have income above 100 percent but less than 120 percent of the Federal Poverty Level and who are entitled to Medicare Part A to receive Medicaid payment of their Part B premium.

Medically Needy includes individuals whose income is too high to qualify for other Medicaid programs, but who have large monthly medical bills. Their Medicaid eligibility is redetermined every month.

Refugees include aliens who are eligible under a special general assistance program.

Qualifying Individuals I (QI 1—formerly PBMO, Part B Medicare Only) are individuals who are entitled to Medicare Part A and who have incomes of at least 120 percent but less than 135 percent of the Federal Poverty Level and who are not otherwise eligible for Medicaid. Medicaid benefits are limited to full payment of the Medicare Part B premiums. Entitlement of individuals is limited by the availability of the capped federal funding allocated to the state.

Qualifying Individuals II (QI 2) are individuals who are entitled to Medicare Part A and who have incomes at least 135 percent but not exceeding 175 percent of the Federal Poverty Level and who are not otherwise eligible for Medicaid. Medicaid benefits are limited to partial payment of the Medicare Part B premiums. Entitlement of individuals is limited by the availability of the capped federal funding allocated to the state.

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