What is AHCA in Florida?

WHAT IS AHCA IN FLORIDA?

The Agency for Healthcare Administration (AHCA) is Florida’s primary health care agency. AHCA is responsible for overseeing many of Florida’s health care programs and finding ways to improve health care services for Florida’s 21.9 million residents (as of 2020). Keep reading to learn more about AHCA’s role in Florida.

A BRIEF OVERVIEW OF AHCA

The Florida Agency for Healthcare Administration was created by Chapter 20, Florida Statutes, as the chief health policy and planning entity for the state. AHCA’s motto is “Better Health Care for All Floridians.” AHCA has wide-ranging responsibilities, including:

• Managing the Florida Medicaid budget (which numbers in the billions of dollars)
• Licensing and regulating over 48,000 health care facilities
• Sharing health care data through the Florida Center for Health Information and Policy Analysis

Per their website, AHCA aims to: “reduce the number of uninsured across the state, to enhance our ability to target fraudulent providers, to reduce unnecessary regulation, and to reduce administrative costs in order to ensure that dollars go to serve patients and more.”

AHCA officials are appointed by Florida’s governor. In 2019, Gov Ron DeSantis tapped Mary Mayhew to lead AHCA. Prior to her appointment in Florida, Mayhew worked for the Center for Medicare and Medicaid Services (CMS), where she oversaw Medicaid at the federal level.

AHCA’S ROLE IN FLORIDA HEALTHCARE

As the health policy and planning entity, AHCA is responsible for a wide range of healthcare-related services in the State of Florida. Among other things, AHCA does the following:

• Administer Florida Medicaid. Medicaid is a medical assistance program that helps thousands of low-income families, elderly people and people with disabilities receive medical services, medications and long-term care. In Florida, AHCA is responsible for administering Medicaid through the Statewide Medicaid Managed Care (SMMC) program that was implemented in 2014. Most Florida Medicaid recipients are enrolled in the SMMC program, which has three components: the Long-Term Care (LTC) program, the Managed Medical Assistance (MMA) program, and the Dental program. On the SMMC website, patients can choose a health care plan, search for providers and find helpful resources.

• Reimburse prescription drugs. AHCA reimburses payment for prescription drugs under the Florida Medicaid covered services. AHCA covers most outpatient prescription drugs, some injectables, and some over-the-counter drugs with a valid prescription. You can see which prescription drugs are covered in the Florida Medicaid Preferred Drug List.

• License and regulate health care facilities. As part of its duties, AHCA licenses and regulates Florida health care facilities, including hospitals, nursing homes, assisted living facilities, home health agencies and ambulatory surgery centers. All in all, AHCA certifies and regulates over 48,000 providers in the State of Florida. Licensed facilities must act in compliance with state and federal regulations and pass routine inspections to continue operating.

• Operate FloridaHealthFinder.gov. AHCA operates and maintains floridahealthfinder.gov, a website that publishes provider information to help Floridians make informed health care decisions. Visitors can find patient rights information, provider and facility data, consumer guides, Medicare and Medicaid information, financial resources, and so much more.

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