Approximately 47 percent of Florida’s children are enrolled in Medicaid and about 85 percent of Florida’s Medicaid population receives services through a managed care delivery system. Children’s Medical Services and AHCA work closely to ensure CYSHCN are provided quality health care and related services through a cohesive system of care. Children are identified during the XIX and XXI eligibility and enrollment process as being potentially clinically eligible for the CMS Plan. Upon referral, CMS conducts clinical eligibility determinations and files are sent electronically daily back to the referring entity.

CMS works with Florida Medicaid, Florida KidCare, and community partners to identify children that are uninsured and underinsured. When a child is identified, the CMS team works to enroll them in the CMS Safety Net Program, which will pay for certain direct services depending on the child’s needs.

The CMS Clinical Eligibility Team is trained to support families calling for clinical eligibility determinations, by assessing for additional needs and providing linkage to resources. This helps Florida families be equipped with information on available resources for their child’s need.

Beginning in February 2019, CMS partnered with WellCare to operate the CMS Plan. Through this new model, the CMS Plan is able to work with providers on value-based care and other innovative and effective payment models. The foundational principles of the CMS Plan were based on the Standards for Systems of Care for Children with Special Health Care Needs 2.0 and design elements reflect feedback from families and the community. The CMS Plan continues to keep care coordination as a cornerstone of the program. Every child is assigned to a care coordinator and interaction frequencies are based on a tiered system. The CMS Plan offers expanded benefits, and special programs, all designed to support the child and family. Beginning in 2019, dental services for CMS Plan Medicaid enrollees are covered under a separate Medicaid dental plan. Performance measures for the CMS Plan are enhanced to include specific child measures, including linkages to PCMHs and transitioning to adult health systems, as well as tracking quality of life measurements.

Through a joint agreement between the Department and AHCA, CMS operates the Children’s Multidisciplinary Assessment Teams (CMAT) in Florida, as well as the Medical Foster Care (MFC) Program. For children and youth referred to MFC or skilled nursing facility services, CMATs provide a thorough multidisciplinary (nursing and social work) assessment. Team members include the child’s parent/guardian, the CMAT Team, a representative from AHCA or the Medicaid Managed Assistance Health Care Plan, a representative from the Agency for Persons with Disabilities, and if under the age of three, a representative from Early Steps. Other relevant stakeholders are also invited to attend and may include MFC staff and child welfare representatives. Through a consensus building process, the level of care is determined, which drives the reimbursement rate for MFC Parent Providers and skilled nursing facilities. The CMAT process also provides a comprehensive review and clinical education of child’s care needs to the members of the child’s team.

Florida’s MFC Program is a partnership between the Department and AHCA, in addition to the DCF. CMS trains MFC parents who are then credentialed with the various Medicaid Managed Care Plans to provide MFC parent provider services for the MFC program. CMS provides child specific trainings, ongoing nursing and social work oversight, and technical assistance to MFC parent providers. CMS collaborates with various stakeholders as part of the MFC program including, but not limited to, biological-preadoptive parents, the Medicaid Managed Care Plan, the child welfare agency (licensing, child protection investigators, case managers, guardian ad-litems, providers, specialists, among others).

CMS administers Early Steps, Florida’s Individuals with Disabilities Education Act, Part C early intervention program. CMS contracts with Early Steps providers across the state, and AHCA participates in monitoring these programs for compliance and program operations.

The Partners in Care: Together for Kids Program is Florida’s Program for All-Inclusive Care for Children. This program is administered by CMS and AHCA and serves children enrolled in the CMS Plan with life threatening and life limiting illnesses. Partners in Care: Together for Kids Program Providers are hospices who deliver pain and symptom management services, including nursing and social services supports, activity therapies, and respite care.

The Behavioral Health Network (BNet) was created pursuant to Florida Statute 409.8135 requiring the Department to contract with the DCF to provide behavioral health services to Title XXI eligible CYSHCN. This is to ensure a high level of integration of physical and behavioral health services and to meet the more intensive treatment needs of enrollees with the most serious emotional disturbances or substance use disorders. BNet is a statewide network of behavioral health service providers who serve non-Medicaid eligible children ages 5 to 19 years with mental health or substance use disorders who are determined eligible for Title XXI benefits, also known as Florida’s KidCare program. BNet treats the entire spectrum of behavioral health disorders and provides both children and their parents with intense behavioral health planning and treatment services for the duration of the child’s enrollment. BNet Service Providers address the family’s needs through in-home and outpatient individual and family counseling; targeted case management; psychiatry services and pharmaceuticals for the child’s behavioral health or substance use condition; and advocacy and wrap-around services to meet each child’s social, educational, nutritional, and physical activity needs. To increase referrals and enrollments to the BNET program, CMS is collaborating with the DCF to rebuild networking, outreach and education for the program to help ensure continued access and enrollment in this valuable program.