Question #1: What is Medicaid called in Florida? What search terms should addiction treatment organizations use when searching for information on Medicaid billing in Florida?
The official name for Medicaid in Florida is SMMC - Statewide Medicaid Managed Care. However, most patients and providers refer to the names of the individual health plans in common speech. Coventry Health Care of Florida, Humana Medical Plan, Molina Healthcare of Florida, Simply Healthcare Plans, South Florida Community Care, Florida True Health, and Sunshine Health Plan are some of the most common health plans Medicaid patients choose in Florida.
Question #2: What is Statewide Medicaid Managed Care in Florida? Does it Cover Addiction Treatment?
Statewide Medicaid Managed Care (SMMC) is a program that began in Florida in 2014. It is currently transitioning to a new iteration in 2025. Under the SMMC program, the vast majority of Medicaid patients are enrolled in participating health plans. These health plans, in turn, administer healthcare to patients using Medicaid rules. The Agency for Health Care Administration in Florida is responsible for managing the SMMC program. Yes, SMMC covers addiction treatment.
Question #3: Are inpatient and outpatient treatment both covered under Florida’s Medicaid plans?
Yes. Florida calls these levels of care “behavioral health day treatment” and “therapeutic behavioral on-site services” or TBOS, for short. Both types of care are covered under Medicaid in Florida. You can read more about these categories in the Agency for Health Care Administration’s Behavioral Health Intervention Services Coverage Policy.
Question #4: What certifications are required to deliver addiction treatment services for Medicaid patients in Florida?
Day services may be rendered by Master’s level certified addiction professionals, certified behavioral health techs, behavior analysts, assistant behavior analysts, college graduates with a degree in human services-related field. Certified recovery peer specialists, certified recovery support specialists, and certified psychiatric rehabilitation practitioners may also render day services when they are supervised by a treating practitioner.
Question #5: What addiction treatment services are NOT covered for Medicaid patients in Florida?
While Florida will cover inpatient, residential, and outpatient treatment for Medicaid patients with SUD, there are a number of services that are not covered under Medicaid rules. For example, Medicaid in Florida will not reimburse for:
Case management services
Partial hospitalization
Personal care services
Psychological testing, psychotherapy, CBT, psychoanalysis, hypnotherapy or long-term counseling
Tutoring and academic support
Travel time
Question #6: What Addiction Treatment Services are Covered by Medicaid in Florida?
The Florida Medicaid Community Behavioral Health Fee Schedule is a great resource for understanding what addiction treatment services are covered for Medicaid patients in Florida. This Medicaid guide took effect in October 2023. This list is packed with useful information for providers and billing departments, including everything from limitations to maximum fees to tele-medicine rules surrounding each addiction treatment service rendered to Medicaid patients in Florida.
Services covered under Florida Medicaid include:
Psychiatric evaluation by a physician (H2000)
Psychiatric evaluation by a non-physician (H2000)
Brief behavioral health status exam (H2010)
Psychiatric review of records (H2000)
In-depth assessment, new patient, mental health (H0031)
In-depth assessment, established patient, mental health (H0031)
In-depth assessment, new patient, substance abuse (H0001)
In-depth assessment, established patient, substance abuse (H0001)
Biopsychosocial evaluation, mental health (H0031)
Biopsychosocial evaluation, substance abuse (H0001)
Psychological testing (H2019)
Limited functional assessment, mental health (H0031)
Limited functional assessment, substance abuse (h0001)
Treatment plan development, new and established patient, mental health (H0032)
Treatment plan development, new and established patient, substance abuse (T1007)
Treatment plan review, mental health (H0032)
Treatment plan review, substance abuse (T1007)
Medication management (T1015)
Behavioral health medical screening, mental health (T1023)
Behavioral health medical screening, substance abuse (T1023)
Behavioral health-related medical services: verbal interaction, mental health (H0046)
Behavioral health-related medical services: verbal interaction, substance abuse (H0047)
Behavioral health-related medical services: medical procedures, mental health (T1015)
Behavioral health-related medical services: medical procedures, substance abuse (T1015)
Behavioral health-related medical services: alcohol and other drug screening specimen (H0048)
Medication-assisted treatment services (H0020)
Psychosocial rehabilitation services (H2017)
Clubhouse services (H2030)
Brief individual medical psychotherapy, mental health (H2010)
Brief individual medical psychotherapy, substance abuse (H2010)
Brief group medical therapy (H2010)
Individual and family therapy (H2019)
Group therapy (H2019)
Therapeutic behavioral on-site services, therapy (H2019)
Therapeutic behavioral on-site services, behavior management (H2019)
Therapeutic behavioral on-site services, therapeutic support (H2019)
Behavioral health day services, mental health (H2012)
Behavioral health day services, substance abuse (H012)
Florida Assertive Community Treatment (H0040)
Bonus Question: Where else can I find information about addiction treatment billing for Florida?
Other posts on our blog, of course! Here’s some good places to start:
Your Complete Guide to Addiction Treatment Insurance Billing in Florida
How to Open an Addiction Treatment Center in Florida
How to Complete Insurance Registration with Florida Blue for Addiction Treatment Centers
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