The purpose of the Florida Agency for Health Care Administration is to assure better health care for all Floridians. The agency is responsible for administering the Medicaid program, licensing and regulating Florida's health facilities, and providing resources that allow Floridians to have more information when making healthcare decisions.

The agency's activities include the following.

• The Division of Medicaid oversees administration of Florida’s Medicaid program, a medical assistance program that provides access to health care for low-income families and individuals and assists the elderly and individuals with disabilities with the costs of nursing facility care and other medical and long-term care expenses. The agency administers the Statewide Medicaid Managed Care (SMMC) program, which includes the Long-Term Care program, the Managed Medical Assistance program, and the Dental program. Most Medicaid recipients are enrolled in the SMMC program. For children, the agency partners with the Florida Department of Children and Families, the Florida Department of Health, and the Florida Healthy Kids Corporation to form the Florida KidCare partnership, which provides free or low-cost healthcare for children from birth through age 18 who meet eligibility criteria. Several bureaus have oversight responsibility. This includes the Bureau of Medicaid Plan Management Operations which has primary oversight of Medicaid’s managed care programs, focusing on the SMMC program, to ensure they are meeting contractual requirements. The Bureau of Quality is responsible for quality measurement and improvement, research and evaluation of Medicaid managed care plans, and monitoring Medicaid managed care clinical outcomes. The Bureau of Recipient and Provider Assistance operates the Medicaid Helpline and is responsible for the development, coordination, and oversight of recipient-facing operations performed by Florida Medicaid.
• The Division of Health Quality Assurance protects Floridians through oversight of health care providers, promoting access to health information, and promoting integrity in the Medicaid program. The division licenses, certifies, or regulates over 30 different types of healthcare providers, including hospitals, nursing homes, assisted living facilities, and home health agencies. In total, the division licenses, certifies, regulates, or provides exemptions for over 50,000 providers. There are multiple bureaus within Health Quality Assurance carrying out these functions. This includes the Bureau of Field Operations which has eight field offices throughout the state and directs facility inspections; maintains records of survey deficiencies and recommends sanctions, fines, and de-certification when necessary; and helps develop facility regulations and procedures and carries out specified quality assurance initiatives. The Office of Medicaid Program Integrity audits and investigates providers suspected of overbilling or defrauding Florida's Medicaid program; recovers overpayments; issues administrative sanctions; refers cases of suspected fraud for criminal investigation; and coordinates with state and federal agencies, such as the Office of the Attorney General's Medicaid Fraud Control Unit, the Centers for Medicare & Medicaid Services Center for Program Integrity, and the U.S. Department of Health and Human Services Office of the Inspector General. In addition, the agency operates the Florida Health Center for Health Information and Transparency, which is responsible for collecting, compiling, analyzing, and disseminating health-related data used to develop public policy and promote transparency of consumer health care information through FloridaHealthFinder.
  

The funding information listed below is provided by Transparency Florida. Additional funding information can be obtained on the State of Florida Fiscal Portal or by contacting the agency.

Information on the agency's performance may be found in its Inspector General Annual Report.

OPPAGA Products
A complete list of related OPPAGA reports and presentations is available on our website.

Other Reports
Florida Agency for Health Care Administration, Medicaid Presentations and Reports
Florida Agency for Health Care Administration, Publications
Florida Agency for Health Care Administration, Statewide Medicaid Managed Care Reports and Guides
A complete list of Florida Auditor General reports is available on its website.

Websites of Interest
Centers for Medicare & Medicaid Services, Medicaid & CHIP in Florida
U.S. Department of Health and Human Services, Health Insurance

Section 20.42, Florida Statutes

Florida Agency for Health Care Administration Contact Website
Florida Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, Florida 32308-5407
(888) 419-3456
Website