Medicaid Annual Eligibility Redetermination Reviews
AmeriHealth Caritas Florida and the Agency for Health Care Administration (AHCA) are preparing for the resumption of Medicaid members’ annual eligibility redetermination reviews. Annual reviews resumed on April 1, 2023.
This federally required process is in place to ensure those enrolled in Medicaid programs continue to meet established eligibility criteria. AmeriHealth Caritas Florida will collaborate with AHCA and our provider network to minimize the burden on our members and promote continuity of health coverage.
If a member has received an eligibility redetermination notice or a request for additional information from the State of Florida’s Department of Children and Families (DCF), it is especially important that they respond promptly to help ensure continuation of their benefit coverage. Additionally, it is critical that DCF has updated contact information for its Medicaid members. If members have moved without informing DCF, they may miss essential information needed to maintain their Medicaid coverage.
Timely recertification is important because it:
- Helps ensure continuity of care for our plan members/your patients.
- Eases administrative burden when verifying member eligibility.
- Avoids the need for resubmission of prior authorization requests for certain services that may be required due to gaps in care caused by lapsed Medicaid coverage.
Supports timely deeming of newborns as Medicaid eligible and ensures mom and baby are both on the AmeriHealth Caritas Florida plan.
How can providers help?
Providers can help by relaying consistent and simple messages to Medicaid members, stressing the importance of responding promptly to any requests for information from the Florida Department of Children and Families. Providers can visit www.amerihealthfl.com with questions and are encouraged to direct members to the AmeriHealth Caritas Florida Member Redetermination Webpage for more information.
Additionally, the following new tools have been launched in the NaviNet Provider Portal that will allow providers to view upcoming Medicaid Member Annual Eligibility Redetermination dates.
New Redetermination Tools in NaviNet Portal
- Medicaid Member Annual Eligibility Redetermination Popup Alert
In the Eligibility and Benefits Screen under the Patient Alert Details popup, there will be a new “Redetermination Report” link that, when clicked, will display the member’s upcoming eligibility redetermination date. The new pop-up alert will be very similar to the existing Care Gap and PCP History alerts and will be available to all provider types.
- Medicaid Member Annual Eligibility Redetermination Report
In the Administrative Report Inquiry section, a new report will be available for PCPs under the report list dropdown that provides a full list of all members on your roster who have upcoming eligibility redetermination dates. The report will be available for PCPs to download in both PDF and excel formats.
You can use these new tools to verify AmeriHealth Caritas Florida members’/your patients’ Medicaid Annual Eligibility Redetermination status. If you receive an alert or report in NaviNet that indicates your plan member has an upcoming eligibility redetermination date, you can help ensure their continued coverage by stressing the urgency of timely recertification and directing those in need of assistance to contact Florida’s Department of Children and Families through their website at or by calling DCF at 1-866-762-2237 (TTY 1-800-955-8771), Monday to Friday, 8 a.m. to 5:30 p.m.
If you have any questions, please feel free to contact your AmeriHealth Caritas Florida Provider Account Executive or call Provider Services at 1-800-617-5727.