The FDOH and the Agency for Health Care Administration (AHCA) renew their interagency agreement every three years and are currently in the process of renewing this agreement.  The purpose of this agreement is to ensure an understanding between the AHCA and FDOH and delineate areas of responsibility regarding the operation and administration of the programs or services such as the Certified Nurse Assistant Registry; Children’s Multidisciplinary Assessment Team; Family Planning Waiver; Healthy Start, Medical Foster Care, and Preadmission Screening and Resident Review. The AHCA may delegate certain programmatic or operational functions related to the administration of the Florida Medicaid program, as directed in Florida law. The AHCA and FDOH are cooperative partners in overseeing certain functions related to programs and services for Medicaid recipients. 

The AHCA is the single state agency responsible for the administration of the Florida Medicaid program, authorized under Title XIX of the Social Security Act (the Act).  In accordance with Title 42 Code of Federal Regulations (CFR), Section 431.10, the AHCA may not delegate and must retain ultimate responsibility and authority to supervise the Florida Medicaid State Plan and waivers and to develop policies, rules, and regulations related to the Florida Medicaid program. 

For this agreement, AHCA’s responsibilities include, but are not limited to:

• Coordinate with FDOH on the submission of Medicaid state plan amendments or waiver amendments related to the programs.
• Provide FDOH with an opportunity to review any proposed Medicaid state plan amendments or waiver amendments related to the programs described in this agreement prior to submission to the CMS.
• Enroll and register Florida Medicaid providers.
• Respond to inquiries from FDOH requesting technical assistance or policy clarifications from AHCA related to duties and responsibilities specified in the interagency agreement.
• Monitor compliance with all aspects of this Agreement.

FDOH is responsible for Florida’s public health system designed to promote, protect, and improve the health of all people in the state. The FDOH is also responsible for oversight and implementation of several federal state-funded programs and services, including:

Coordinate with AHCA on Medicaid state plan amendments, legislative budget requests, administrative rules, and contracts related to the programs described in the agreement.

Participate in stakeholder meetings that are relevant to the programs described in this agreement.

• Provide AHCA with programmatic information, upon request, for delegated activities specified in the agreement to address federal reporting requirements or to be responsive to state and/or federal audit requests or findings.
• Administration of maternal, infant, and child health programs.
• Administration of the Children's Medical Services program to provide services for children with or at risk of having health care needs.
• Regulation of nursing professionals, including certified nursing assistant.
• Providing the following County Health Department services:
  • Basic family healthcare,
  • Infectious disease control; and
  • Environmental health services.

• Determining medical eligibility and/or the level of Medicaid reimbursement through the Children's Multidisciplinary Assessment Team (CMAT) for:
  • The Model Waiver,
  • Nursing facility services for individuals under the age of 21 years; and
  • Medical foster care (MFC) services.
• Operation and programmatic management of the Family Planning (FP) Waiver

In order for Medicaid administrative expenditures to be claimed for federal matching funds, the following requirements must be met:

• Costs must be “proper and efficient” for the state’s administration of its Medicaid state plan (Section 1903(a) of the Act). 
• Costs related to multiple programs must be allocated in accordance with the benefits received by each participating program (OMB Circular A-87, as revised and now located at 2 CFR 200). This is accomplished by developing a method to assign costs based on the relative benefit to the Medicaid program and the other government or non-government programs.
• Costs must be supported by an allocation methodology that appears in the state’s approved Public Assistance Cost Allocation Plan (42 CFR 433.34).
• Costs must not include funding for a portion of general public health initiatives that are made available to all persons, such as public health education campaigns.
• Costs must not include the overhead costs of operating a provider facility.
• Costs must not duplicate payment for activities that are already being offered or should be provided by other entities or paid through other programs.
• Costs may not supplant funding obligations from other federal sources.
• Costs must be supported by adequate source documentation.

The AHCA and the FDOH have implemented the Family Planning Medicaid Waiver Program, also known as "Family Planning Medicaid for Today's Woman." A woman may qualify for this program if she:

• Is between the ages of 14 and 55
• Has lost full Medicaid services for any reason in the past 24 months
• Wants to have family planning services
• Is not pregnant
• Has not had a hysterectomy or sterilization
• Has a household income less than or equal to 185% of the current federal poverty level
• Services include under the Family Planning Medicaid Waiver Program include:
• Physical exams which may include a pap smear, breast exam, and sexually transmitted disease testing
• Family planning counseling and pregnancy test
• Birth control supplies including condoms
• Colposcopies and treatment for STDs which are limited to a six-week period after a family planning exam, counseling visit, or supply visit
• Related pharmaceuticals (medicines and antibiotics) and laboratory test

As a result of the implementation of the Federal Omnibus Budget Reconciliation Act of 1989, Florida Medicaid expanded reimbursement for medically necessary services to children with complex medical needs. The CMAT within the FDOH, is an interagency coordination effort of AHCA, DCF, and the Agency for Persons with Disabilities, and ensures individuals under 21 years of age with complex medical needs, are assessed and staffed to determine the medical eligibility level of care most appropriate for nursing facility or Model Waiver services.

The CMAT in combination with parents or legal representatives and identified community-based resources, shall:

• Assist the child’s family or legal representative in acquiring the knowledge, skills, supports, and services needed to meet medical, developmental, educational, and emotional needs.
• Provide information on alternative settings for long-term care services when services in the biological home are not possible.
• Prevent or reduce prolonged stays in hospitals upon identification of a child in need of long-term care services.
• Schedule and invite all applicable agencies, entities, and participants for the level of care determination staffing when nursing facility or Model Waiver services are requested, or when seeking continuation.
• Provide referrals to caregivers for technical assistance and guidance.
• Educate parent(s), and legal representatives, as applicable, on the requirements for program and service eligibility.
• Provide a person-centered care and service plan for the child receiving Model Waiver services.

The Medical Foster Care (MFC) Program is a coordinated effort between the Florida Medicaid Program within AHCA, DOH Children’s Medical Services, and the DCF’s Community Based Care Program to provide family-based care for medically complex children under the age of 21 in foster or shelter care status who cannot safely receive care in their own homes. The MFC Program establishes and trains foster parents to provide MFC services for children that are assigned to the provider’s care by identifying and approving through the CMAT process. 

CMS provides the assessment and staffing services for CMAT and provides medical consulting, nursing and social work care coordination, and administration of the MFC program.  The objectives of MFC are to:

• Reduce the high cost of medical treatment associated with medically complex and fragile children by eliminating the need for long-term institutional care.
• Enhance the quality of life and allow medically complex and fragile foster children to receive home-based services specific to their medical needs that will enable children to develop to their fullest potential.
• Return children to a safe home with birth parents or relatives as soon as possible.
• Facilitate the provision of a timely alternative permanent placement for children who cannot be returned to their families of origin.
• Reduce the risk of medical neglect or abuse for children once they are returned to their own homes.
• Ensure that families who are reunited with children who have continuing medical problems will receive medical training in the care of their child prior to his or her return.