Ped-I-Care is a managed health program that administers health insurance benefits for children with special health care needs (CSHCN) whose families have a low income. We are contracted with Children’s Medical Services Managed Care Plan (CMS Plan) of Florida for Title 21, or CHIP, as well as Title 19, or Medicaid (Managed Medical Assistance) benefits. The program’s official name is the Pediatric Integrated Care System; “Ped-I-Care” is a shortened version of that. Ped-I-Care was founded in 2003, and has steadily grown with each passing year. We now offer Title services in 51 Florida counties for both Title 19 and Title 21.
Ped-I-Care is part of the Department of Pediatrics at The University of Florida. Through our contract with CMS Plan we are able to help tens of thousands of children access the care they need and deserve.
What We Value
The foundation for Ped-I-Care is the medical home. It is our goal to work with Children’s Medical Services Plan (CMS Plan) Nurse Care Coordinators so that every child has a medical home, with the primary care physician (PCP) central to the management of each child’s needs. Our goal is to offer high-quality choices to families, along with the right guidance and support, so that each child’s health is optimized. In all that we do, Ped-I-Care works to provide services in a culturally and linguistically competent manner.
What We’re Known For
Ped-I-Care has built a reputation for meeting and exceeding the standards it’s held to. Our history includes member satisfaction is the highest known in the nation; our provider satisfaction is very high; our rates of child health check-ups and vaccinations are excellent; and our members’ use of the ER is lower than that of other plans. We have realized substantial savings for the state of Florida while surpassing our quality improvement and utilization management goals. Ped-I-Care has won a national award for these types of achievements and has presented research at regional conferences on various topics, including cultural competence.
Under the Managed Medical Assistance (MMA) component of the Statewide Medicaid Managed Care (SMMC) program, Children’s Medical Services (CMS) has formed a health plan known as Children’s Medical Services Managed Care Plan (CMS Plan). In 2014, CMS Plan signed a contract with the Florida Agency for Healthcare Administration (AHCA) to provide Medicaid services in the SMMC. The SMMC was authorized by the 2011 Florida Legislature through House Bill 7107, creating Part IV of Chapter 409, F.S. It was designed to establish the Florida Medicaid Program as a statewide, integrated managed care program for all covered services, including long-term care services.
CMS Plan has contracted with two Provider Service Networks (PSNs), Ped-I-Care (in 51 counties) and South Florida Community Care Network (SFCCN) in 16 counties, to provide a number of administrative services for the plan.
Ped-I-Care covers the following counties:
Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Citrus, Clay, Columbia, Dixie, Duval, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Highlands, Hillsborough, Holmes, Jackson, Jefferson, Lafayette, Lake, Leon, Levy, Liberty, Madison, Marion, Nassau, Okaloosa, Orange, Osceola, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Seminole, St. Johns, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, and Washington.
SFCCN covers the following counties:
Broward, Charlotte, Collier, DeSoto, Glades, Hendry, Indian River, Lee, Manatee, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach, Sarasota, and St. Lucie.
The purpose of the CMS Plan is to provide care to children with special health care needs (CSHCN) up to the age of 21 years. It has been implemented in collaboration with the local CMS offices, which continue to provide nurse care coordination for the members and providers.
Ped-I-Care and SFCCN are sometimes referred to as, “The ICSs,” with ICS as an abbreviation for Integrated Care System. Ped-I-Care is a program operating under the auspices of The University of Florida, College of Medicine’s Department of Pediatrics. SFCCN is a collaboration of 2 of the largest public health systems in Florida, Broward Health and Memorial Health Systems. Both Ped-I-Care and SFCCN are under contract to the Department of Health’s (DOH) Children’s Medical Services (CMS) Division.
The program is designed to respond to the legislative intent to create a statewide initiative to provide for a more efficient and effective service delivery system that enhances quality of care and client outcomes in the Florida Medicaid program. Our goal, therefore, has been to develop a program that is sensitive and responsive to the special needs of children participating in CMS, and yet function cost-effectively within the Medicaid funding environment.
The objectives are to:
- Develop and maintain a comprehensive provider network that offers community-based primary care and ancillary services, as well as high-quality specialty care and hospital services;
- Deliver and coordinate quality primary and specialty care; and
- Evaluate and continually improve the quality of service delivery, including participation in preventive care, such as Child Health Check-ups and immunizations, as well as assessment of member satisfaction.
The University of Florida Department of Pediatrics and South Florida Community Care Network are committed to caring for children and have an established track record of collaboration with CMS and CMS Plan in providing services to children with special health care needs. Accepting responsibility for implementing this health plan to participate in MMA is an important step in continuing to pursue our role as providers of health care in the environment of cost containment. We invite all our providers to work closely with us as we pursue this new and exciting opportunity to offer quality care to children with special health care needs who receive Florida Medicaid benefits.