Staywell Health Plan of Florida

Staywell is one of several Florida health care plans that work with Medicaid recipients. The program is a managed care plan, meaning that enrollees see a primary care physician, or PCP, who makes coordinates all aspects of patient care. Managed care plans typically reduce the cost of medical services by eliminating unnecessary or duplicate treatments.

Staywell is not available statewide. You must be a resident of one of the 19 counties served by the plan. If you enroll in Staywell and then move to a county not served by Staywell, you may lose the ability to remain in the plan, but you will not lose your Medicaid coverage. You may also be able to enroll in one of the Florida health plans in your new area that is similar to Staywell.

You must be eligible for Medicaid to join the Staywell program. Generally, Medicaid recipients belong to one of three groups: low-income families with children; elderly, disabled or blind adults; and participants in the Supplemental Security Income program, also referred to as SSI. Staywell does not make eligibility determinations. The Social Security Administration determines SSI eligibility, and the Florida Department of Children and Families determines eligibility for the other two groups.

If your child is enrolled in the MediKids program, he or she is eligible for Staywell. MediKids is another of the Florida health insurance plans that strive to provide preventive care to children, along with services needed to treat a disease or injury. MediKids is available for children who are five years of age or younger and whose family incomes do not exceed the limits set by the state for the family size. Unlike Medicaid, the MediKids program requires parents to pay a small premium each month, with the amount of the premium based on income and family size.

Staywell provides the basic services covered by Medicaid. These include routine checkups for children, chiropractic care, medically necessary vision and hearing care, most transplants and dialysis care. Office visits to your physician, hospital care, outpatient surgery, medically necessary care in your home, hospice care, qualified midwife care and nursing home care are also covered. So, too, are speech, physical, occupation and respiratory therapies.

Some services require advance approval from Staywell or a referral from your PCP. However, approval is not necessary for some specialists as long as you choose a provider from the Staywell directory. You can visit your chiropractor, dermatologist or podiatrist without obtaining advance approval. Females do not need a referral to visit their gynecologists or obstetricians annually, but additional visits should be routed through their primary care physicians. Family planning services and necessary vision care services do not require advance approval. Many outpatient psychiatric care services can also be obtained without referrals, but it is best to check with Staywell if you are uncertain whether a referral is required.

Members of the Staywell program have access to certain benefits that are not traditionally included in Medicaid. As a Staywell member, you can call a 24-hour helpline to speak with a nurse about your illness or injury. The call can help you decide whether you need to schedule a visit with your doctor, go to the emergency room or treat your condition at home. Staywell also has a maternity education program that teaches pregnant women how to take care of themselves and their babies during pregnancy and after birth. Expectant mothers can also participate in Staywell’s Prenatal Reward Program and earn a free stroller. If you have a chronic health condition, such as diabetes, asthma or hypertension, you can participate in one of Staywell’s case management programs to learn more about your condition or find additional resources.

In addition to your approved prescription medications, you can receive $25 per month in non-prescription items for your family. You can choose medical supplies, vitamins or over-the-counter medications from the list on the Staywell website. After making your selection, call the toll-free number to submit an order. Your items are shipped to your home.

It is important to remember that Florida requires virtually all Medicaid recipients to choose a managed care program. If you do not make a selection, the state will assign you to a plan. Evaluate your options carefully, and then choose the plan that is most suited to your needs.