Does the Florida AMFC program impact insurance? Learn about the program and how it affects Medicaid eligibility.

How does the Florida AMFC program impact insurance? The answer to this question is crucial for families navigating Medicaid and insurance eligibility.

The Home Health Aides for Medically Fragile Children (AMFC) program may have unintended consequences on a family’s Medicaid eligibility. Income earned through this program by a caregiver could be factored into the household’s income when determining Medicaid eligibility for the child or other family members.

As a result, some families may find their Medicaid eligibility impacted by this extra income, potentially disqualifying them from receiving essential healthcare services.

What is the Florida Home Health Aide for Medically Fragile Children Program?

The Home Health Aide for Medically Fragile Children Program was established as part of House Bill 391, passed by the Florida Legislature in 2023. This program allows eligible family members to become trained and certified to provide home health aide services to children with medically complex conditions under Medicaid.

Through this program, eligible family members can be reimbursed by Medicaid for caregiving services provided to these children, improving their quality of life and reducing the need for institutional care.

Under the program, family members, such as parents or other close relatives, can be paid to provide essential healthcare services like nursing assistance or daily medical support at home. These services, previously only offered by certified healthcare providers, now allow family caregivers to step in and fill this vital role while receiving compensation.

How Do Families Participate in the AMFC Program?

Families must connect with a Medicaid-approved home health agency, such as Atlantic Care Services, to participate in the Florida Home Health Aide for Medically Fragile Children program.

The caregiver, typically a parent, legal guardian, or close relative, must meet eligibility criteria and complete an 86-hour training program. This training covers various medical topics, including theoretical nursing education, basic nursing skills, clinical training under the supervision of a registered nurse, CPR certification, and specialized training on HIV/AIDS and medication administration.

Caregivers must be at least 18 years old, able to read and write and pass a background check. Once training is complete, the home health agency employs the caregiver, enabling Medicaid reimbursement for their services.

 The program is not limited to parents—it can include any family member, such as aunts, uncles, grandparents, or siblings, who meet the eligibility and training requirements. Children eligible for the program must be 21 or younger, have a physical, mental, or cognitive impairment, and qualify for Medicaid skilled or respite care services.

Does the AMFC Program Affect Medicaid Eligibility?

Yes, the income earned by family caregivers under the AMFC program can impact Medicaid eligibility. If a caregiver earns compensation for providing health aide services to a medically fragile child, that income will be considered part of the household income for Medicaid purposes.

As a result, families may face income limits that could affect their child’s Medicaid eligibility. In Florida, Medicaid eligibility is based on household income, and exceeding certain thresholds may disqualify the family from receiving Medicaid benefits.

While this issue has been identified by the Agency for Healthcare Administration (AHCA), the agency is aware of the potential conflict and is working on changing the eligibility requirements to address the concerns of families. For now, it’s crucial for caregivers and families to remain vigilant about their household income levels to avoid inadvertently affecting Medicaid eligibility.

Families can refer to the Florida Medicaid Member Portal or consult the Department of Children and Families for further information about income limits and the potential impact on Medicaid eligibility.

What Impact Does This Have on Other Insurance?

Families may also ask does the Florida AMFC program impact insurance other than Medicaid, such as private insurance or employer-sponsored health plans. Generally speaking, Medicaid eligibility is the most directly impacted by the income earned through this program, but families should be aware of their total household income when considering other insurance options.

Updates and Changes to the Program

The AHCA is aware of the concerns surrounding income limits and Medicaid eligibility for families participating in the AMFC program. As such, AHCA is exploring options to modify the program’s requirements, ensuring that families can receive the compensation they need for caregiving without jeopardizing essential Medicaid coverage. However, these changes are still under discussion, and families should continue to stay informed and up to date on any updates regarding the program.

Florida Healthy Kids is not participating in the AMFC program, which could further complicate the eligibility process for families relying on this health insurance coverage.

Stay Informed to Protect Medicaid and Insurance Benefits

The Florida Home Health Aide for Medically Fragile Children program offers vital support for families but may affect Medicaid eligibility due to caregiver income. Families must stay informed and consult with agencies like Atlantic Care Services to understand how this program may impact household income and Medicaid benefits.

If your family is considering participating in the program, contact us today for guidance on protecting your child’s Medicaid and insurance coverage.