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Medicaid : Florida Healthease Kids Benefits

Covered Services and Co-Payments

Benefits	Co-Payment
Well-Child Care and School Physicals	$0
Office Visits for Minor Illnesses, Accident Care (PCP)	$5*
Specialist Office Visit(if referred by PCP)	$5
Hospital Inpatient Medical and Surgical Care	$0
Unauthorized Use of Emergency Services (Co-payment is waived if visit is appropriate use of ER, PCP has authorized or patient is admitted to the hospital)	$10
Emergency Transportation	$10
Surgeon’s Fees	$0
Prenatal Care and Delivery (Up to 3 days maximum)	$0
Pharmacy Coverage (Includes all drugs available under the Florida Medicaid program)	$5
Generic Prescriptions (31-day supply)	$5
Brand Name Prescriptions (Available only if no generic is available or if brand name is considered medically necessary)	$5
Behavioral Health Services Outpatient Services (Benefit limitations shall not be any less favorable than those for physical illnesses generally)	$5
Inpatient Services (Benefit limitations shall not be any less favorable than those for physical illnesses generally)	$0
Substance Abuse Rehabilitation and Treatment Outpatient Services (Benefit limitations shall not be any less favorable than those for physical illnesses generally)	$5 per session
Inpatient Services (Limited to not more than 7 inpatient days per contract year for medical detoxification only and 30 days for residential services)	$0
Diagnostic Testing (Laboratory, X-rays)	$0
Anesthesia Services	$0
Outpatient Physical, Occupational, Respiratory and Speech Therapies (Up to 24 sessions within a 60-day period per episode or injury, with the 60 day period beginning with the 1st treatment.)	$5 per session
Home Health Services (Skilled nursing only; includes Hospice services)	$5
Skilled Nursing Facility (Pre-authorized, 100 days per year)	$0
Durable Medical Equipment and Prosthetic Devices (Pre-authorized, medically necessary equipment)	$0
Routine Vision and Hearing Screening	$0
Refractions/Corrective Lenses (1 pair every 2 years or when head size or prescription changes warrant)	$10
Chiropractic Services (24 visits per calendar year)	$5
Organ Transplants (Includes pre-transplant, transplant and post-transplant services when authorized by insurer at approved facility)	$0
OTC Program ($10 per family per month) (Select your choice of over-the-counter items and they will be mailed straight to your door)	$0