Medicaid 2025 UPDATES!

Date Published: February 11, 2025

Please note: This only applies to Florida Assisted Living Facilities!

United Healthcare recently shared with us the below memo regarding changes to their LTC authorization processes for ALFs.

Please let us know if you have any questions or needs anything additional.

We are sending this message to help clarify some of the confusion that has transpired with authorizations in relation to the Florida Medicaid Long Term Care member enrollment period.

Please Note: Long Term Care Authorizations will be waived until February 28, 2025.

ELIGIBILITY: Please be sure to check the UnitedHealthcare Provider Portal to verify member eligibility. We recommend keeping a print screen with the date the information was verified.

EXISTING MEMBERSHIP:

If you cannot find a new authorization, use the authorization that you have on file.

COC: New membership follows the AHCA Continuity of Care (COC) requirements:

The Managed Care Plan shall be responsible for the costs of continuation of services, without any form of authorization and without regard to whether such services are being provided by participating or non-participating providers for up to sixty (60) days after the effective date of enrollment.

NEW PROCESS for Long Term Care Authorizations:

UnitedHealthcare is transitioning to an Open-Ended Authorization process. 

1. New Authorizations will no longer have end dates unless member(s) either disenroll from the LTC program, change to a different Health Plan, or become deceased.
2. Open-ended authorizations will reflect services in per month increments.
3. Authorizations will be updated, and providers will be notified if/when the member(s) plan of care changes (change in hours/units).

• TRANSPORTATION:  

If your member(s) are not showing active for ModivCare transportation, please search by Member Name and Date of Birth (DOB). Subscriber ID numbers are being transitioned based on new enrollment and may not be located using the member(s) ID number.

• CONTACT INFORMATION:

 Care Manager mailbox:    fl_ltc_cm@uhc.com

• Provider Relations Advocates

Thank you for your patience, your partnership, and your continued great care to our UnitedHealthcare Long Term Care members.

If you have questions or need assistance, please send a email to: Contact UHC

Please note: This only applies to Florida Assisted Living Facilities!

Florida’s official roll out of the Medicaid Program contracts for 2025-2030 begins on February 1^st.

Items to note: 

Regions have changed from numerical to alphabetical. New SMMC Regions

Many of the same health plans are in place with only a few changes SMMC Health and Dental Plans

If a patient is receiving active treatment under a current authorization and changed plans, there is a minimum of a 60-day transition period where a new authorization is not required; this also applies to providers that are out of network with the new payer. However, best practice is to notify the new plan of the treatment in process.  SMMC Snapshot