Medicaid and the
Medically Fragile Child
Florida Medicaid. It is a wonderful benefit
for those in need, but it can also be very
confusing. Several years ago, the state of
Florida implemented a Statewide Medicaid
Managed Care (SMMC) Program. This
program requires most recipients to be
enrolled in a Managed Medical Assistance
(MMA) plan contracted with the State of
Florida to administer their Medicaid benefits.
This style of healthcare works well with the
typical family, keeping the Primary Care
Physician in the role of directing the care and
offering a variety of services and providers.
However, not every family is a typical
family. If your family includes a child with
special needs, that child may not fit well
into the managed care approach. Children
with more complex medical issues may
see their specialists more often than their
pediatrician. They require specialized
medical equipment and therapies on a more
consistent basis. Most importantly, their
needs must be addressed in a timely manner
as their development and future potential
can be negatively affected by delays in service
delivery.
For this reason, many of us in the state
of Florida that work with medically fragile
children lobbied for an option for these
special children. As a result, specific groups
of children with special needs were deemed
“voluntary”. This means that they are not
required to enroll in the MMA program.
They can choose to enroll in an MMA plan,
or they can choose to receive their medical
services through traditional “Fee for Service”
(FFS) Florida Medicaid.
Examples of “qualified child” is any child
who is a Medicaid recipient and is:
• Enrolled in a PPEC (Prescribed Pediatric
Extended Care) center. PPEC centers
are day treatment programs that care for
medically fragile infants and children,
for up to 12 hours per day. They provide
nursing and therapy (OT, PT, ST), in a
child friendly center directed by the child’s
own pediatrician and specialty physicians.
• Enrolled in, or on the waiting list for, the
Home & Community Based Service Waiver
• A resident in a group home facility licensed
under Chapter 393
(A full list of individuals with “voluntary”
participation in MMA can be found in FS
409.972)
There is not a “right” or “wrong” answer
to which plan, an MMA or FFS, is best
for your medically fragile child. That is a
decision made by you based on your child’s
individual needs. If you are the caregiver
for a child that qualifies for this voluntary
status, it is important for you to know that
you have a choice! If your qualified child is
currently enrolled in an MMA and you feel
that there are delays in service authorizations,
you may want to consider choosing FFS.
Talk with your child’s current providers to
ensure that they accept FFS Medicaid. If
they do, and you would like to make that
change, speak with your PPEC Director or
your Developmental Disabilities Waiver case
manager to assist you in the process. Most
importantly, be informed on the options
available to your child as their needs may
change as they grow!
Linda Brown is the president and owner
of BrightStart Pediatrics, a PPEC program.
BrightStart serves Central Florida from
locations in Winter Garden, Sanford and
Orlando. For more information visit online at
brightstartpeds.com.
by Linda Brown, BrightStart Pediatrics
Orlando Early Childhood — Winter/Spring 2019-20 29
/brightstartpeds.com