Medicaid is the medical assistance program that provides access to health care for low-income families and individuals.
The Division of Health Quality Assurance protects Floridians through oversight of health care providers.
Our Agency was statutorily created by Chapter 20, Florida Statutes as the chief health policy and planning entity for the state.
The Florida Agency for Health Care Administration created FloridaHealthFinder.gov to provide easy access to health care information.
You can help protect your tax dollars by reporting suspected fraud by phone, through the Internet or by regular mail.
Medicaid is the medical assistance program that provides access to health care for low-income families and individuals. Medicaid also assists the elderly and people with disabilities with the costs of nursing facility care and other medical and long-term care expenses.
In Florida, the Agency for Health Care Administration (Agency) is responsible for Medicaid. The Agency successfully completed the implementation of the Statewide Medicaid Managed Care (SMMC) program in 2014. Under the SMMC program, most Medicaid recipients are enrolled in a health plan. Nationally accredited health plans were selected through a competitive procurement for participation in the program.
In 2011, the Florida Legislature created Part IV of Chapter 409, Florida Statutes, directing the Agency to create the Statewide Medicaid Managed Care (SMMC) program. The SMMC program has two key components: the Managed Medical Assistance program and the Long-term Care program.
The Assistant Deputy Secretary for Medicaid Finance and Analytics is responsible for the oversight of the Bureaus of Medicaid Program Finance and Medicaid Data Analytics.
The Assistant Deputy Secretary for Medicaid Operations is responsible for the Bureaus of Medicaid Plan Management Operations, Medicaid Fiscal Agent Operations, and Recipient and Provider Assistance, and Enrollment Broker Operations.
The Assistant Deputy Secretary for Medicaid Policy and Quality oversees the Bureaus of Policy and Quality.
The Program Coordination Section is responsible for the development and implementation of infrastructure to support project/initiative tracking and accountability, and project management and process improvement efforts for the Division of Medicaid. The Program Coordination Section is also responsible for the coordination and support of Division of Medicaid activities including correspondence, public records, Medicaid provider alerts and the Quarterly Medicaid provider bulletins, maintenance of the Florida Medicaid provider Training e-Library, coordination of the Medical Care Advisory Committee and other cross divisional activities.
Please click on the link below to view a high level organizational chart of the Medicaid Division. This organizational chart will help you navigate our site.
The Division of Health Quality Assurance protects Floridians through oversight of health care providers. The Division is funded with more than $49 million in state and federal funds. Health Quality Assurance licenses and/or certifies and regulates 40 different types of health care providers, including hospitals, nursing homes, assisted living facilities, and home health agencies. In total, the Division licenses, certifies, regulates or provides exemptions for more than 42,000 providers.
Provides services and support to the other five bureaus within the Division of Health Quality Assurance. The Bureau of Central Services is comprised of four units: The Background Screening Unit, The Financial Analysis Unit, The Central Intake Unit, and the Training and Support Unit. These units are responsible for the receipt and distribution of all health care facility applications and associated fees; the background screening of facility owners, administrators, and personnel; the financial analysis of health care facilities; and the data support and training within the Division of Health Quality Assurance.
Completes onsite surveys to determine compliance with state licensure requirements, but also compliance with federal certification requirements for certified facilities. Additionally, this bureau is responsible for handling consumer complaints. View our map to find your local field office.
Handles health care licensure, Medicare and Medicaid certification, and regulation for hospitals, ambulatory surgical centers, home health agencies, hospices, clinical laboratories, nursing homes, assisted living facilities and all other types of health care providers. The Bureau also includes the health care risk manager licensure program, the organ donor education/registry program, and commercial managed care programs, and is the location of the certificate of need (CON) program, which reviews applications for new facilities and certain specialized services at hospitals, nursing homes, hospices and intermediate care facilities for the developmentally disabled.
The Office of Plans and Construction is primarily responsible for ensuring that hospitals, nursing homes, ambulatory surgical centers, and Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) are safe, functional, and provide safety-to-life for the patients and residents.
The Florida Center for Health Information and Policy Analysis (Florida Center) is responsible for collecting, compiling, analyzing and disseminating health related data. Promotes the adoption of electronic health record systems through health information exchange, electronic prescribing and personal health records software in partnership with health care stakeholders statewide. The Florida Center collects adverse incident reports from hospitals, ambulatory surgery centers, HMOs, nursing homes, and assisted living facilities.
Mary C. Mayhew is Secretary of the Florida Agency for Health Care Administration. In this role, Mary leads a $29.4 billion health care enterprise, representing close to 31% of Florida’s total state budget, and is responsible for health policy and planning for the State of Florida. As Secretary, she administers the state’s Medicaid program ensuring the comprehensive healthcare needs of close to 4 million Floridians are met every month. Additionally, her oversight extends to the licensure and regulation of over 50,000 health care facilities across the 3rd largest state in the nation, and is charged with promoting the transparency of consumer health care information through the Agency’s Florida Center for Health Information and Transparency.
She has set a bold agenda to put Floridians at the center of health care decision-making. Mindful that patients must be empowered to transform the healthcare marketplace, Mary has spearheaded efforts on behalf of Governor DeSantis to accelerate the transparency of facility and provider-level health care pricing and further link provider pricing data to facility level quality data. Equally important have been Mary’s efforts to bend the health care cost curve by bringing greater accountability to providers and health plans operating in Florida. To that end, Mary has convened hospitals, health plans and providers across Florida to ensure they are collectively focused on driving adherence to research-based clinical services and best practices, improving timely access at the most appropriate level of care, and reducing inappropriate use.
Our Agency was statutorily created by Chapter 20, Florida Statutes as the chief health policy and planning entity for the state. We are primarily responsible for the state's estimated $25.2 billion Medicaid program that will serve a projected 4.27 million Floridians in SFY 2016-17, the licensure of the state's 48,500 health care facilities and the sharing of health care data through the Florida Center for Health Information and Policy Analysis.
This year we are working to continue 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.
To file a health care facility complaint, call (888) 419-3456, or complete the Health Care Facility Complaint Form. Search our FloridaHealthFinder.gov site to see if the facility you have concerns about is one that is regulated by our Agency.
For more information on our hotline, please visit Consumer Complaint, Publication and Information Call Center.
To contact specific bureaus or department, including those which license Florida health care providers, please look Inside AHCA for the department you require
For more information on AHCA, please visit Consumer Information.
For questions or information, you may contact the Agency for Health Care Administration by feedback form or by phone toll-free at (888) 419-3456.