AHCA CONTRACT NO. FA619 AMENDMENT NO. 1
Exhibit
10.1
AHCA
CONTRACT NO. FA619
AMENDMENT
NO. 1
THIS
CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and
HEALTHEASE OF FLORIDA, INC., hereinafter referred to as the
"Vendor" or “Health Plan”, is hereby amended as follows:
|
1.
|
All
references in the Contract to the Vendor’s company name are hereby changed
from HealthEase of Florida, Inc. and/or HealthEase Health Plan of
Florida,
Inc. to HealthEase of Florida, Inc.. The Vendor’s contact
information, including names, addresses and telephone numbers and
the
Vendor’s XXXX number remain
unchanged.
|
|
2.
|
Standard
Contract, Section III, Item C., Contract Managers, sub-item 2. is
hereby
amended to now read as follows:
|
|
|
2.
|
The
Vendor’s Contract Manager’s name, address and telephone number for this
Contract is as follows:
|
|
|
Xxxxxxxx
X. Xxxxxx
|
|
|
Healthease
of Florida, Inc.
|
| 0000 Xxxxxxxxx Xxxx |
| Xxxxx, XX 00000-0000 |
| (000) 000-0000 |
|
3.
|
Attachment
I, Scope of Services, is hereby amended to include Exhibit II-A,
Revised
Capitation Rates, attached hereto and made a part of the
Contract. All references in the Contract to Exhibit II,
Capitation Rates, shall hereinafter also refer to Exhibit II-A, Revised
Capitation Rates, as appropriate.
|
|
4.
|
Attachment
I, Scope of Services, is hereby amended to include Exhibit III-A,
September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation
Rates, attached hereto and made a part of the Contract. All
references in the Contract to Exhibit III, September 1, 2006 – August 31,
2007 HMO Rates, shall hereinafter also refer to Exhibit III-A, September
1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates,
as
appropriate.
|
|
5.
|
Attachment
II, Medicaid Prepaid Health Plan Model Contract, Section V, Covered
Services, Item C, Expanded Services, sub-item 2 is hereby deleted
in its
entirety and replaced with the
following:
|
2. The
following is a list of the Health Plan’s Expanded Services:
|
|
a.
|
Annual
comprehensive oral exam, x-rays (one (1) per year), two (2) cleanings
per
year, silver amalgam fillings, one periodontic deep cleaning per
year, two
(2) periodontic scaling and root planing per
year.
|
|
|
b.
|
Up
to $25 credit per household each month for selected over the counter
drugs
and/or health supplies.
|
|
|
c.
|
Unlimited
eye exams and eyeglasses, if medically
necessary.
|
|
|
d.
|
Free
approved round trip transportation to medical
appointments.
|
|
|
e.
|
Circumcision
up to one (1) year.
|
AHCA
Contract No. FA619, Amendment No. 1, Page 1 of 2
AHCA
Form
2100-0002 (Rev. NOV03)
HealthEase
of Florida, Inc. Medicaid HMO
Contract
6. This
Amendment shall have an effective date of September 1, 2007, or the date on
which bothparties execute the Amendment, whichever is later.
All
provisions in the Contract and any attachments thereto in conflict with this
Amendment shall be and are hereby changed to conform with this
Amendment.
All
provisions not in conflict with this Amendment are still in effect and are
to be
performed at the level specified in the Contract.
This
Amendment and all its attachments are hereby made a part of the
Contract.
This
Amendment cannot be executed unless all previous amendments to this Contract
have been fully executed.
IN
WITNESS WHEREOF, the parties hereto
have caused this nine (9) page Amendment (which includes all attachments hereto)
to be executed by their officials thereunto duly authorized.
|
HEALTHEASE
OF FLORIDA, INC.
|
STATE
OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION
|
|
|
SIGNED
BY: /s/ Xxxx X. Xxxxx
|
SIGNED
BY: /s/ Xxxxxx Xxxxxxxx
|
|
|
NAME: Xxxx
X. Xxxxx
|
NAME: Xxxxxx
X. Xxxxxxxx, M.D.
|
|
|
TITLE: CEO
|
TITLE: Secretary
|
|
|
DATE: 9/4/07
|
DATE: 9/6/07
|
List
of
attachments included as part of this Amendment:
|
Specify
Type
|
Letter/Number
|
Description
|
|
Exhibit
|
II-A
|
Revised
Capitation Rates (2 Pages)
|
|
Exhibit
|
III-A
|
September
1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates
(5
Pages)
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FA619, Amendment No. 1, Page 2 of 2
AHCA
Form
2100-0002 (Rev. NOV03)
HealthEase
of Florida, Inc. Medicaid HMO Contract d/b/a
HealthEase
EXHIBIT
II-A
REVISED
CAPITATION RATES
A. Table
2 - General Capitation Rates plus Mental Health Rates:
Area
2 Counties:
|
County
|
Provider
Number
|
|
Liberty
|
015019342
|
|
Jefferson
|
015019318
|
|
Madison
|
015019322
|
|
Wakulla
|
015019336
|
B. Table
4 - General Capitation Rates plus Mental Health Rates and Transportation
Rates:
Area
1 Counties:
|
County
|
Provider
Number
|
|
Escambia
|
015019314
|
|
Santa
Xxxx
|
015019331
|
Area
2 Counties:
|
County
|
Provider
Number
|
|
Xxxxxxx
|
015019340
|
|
Gadsden
|
015019315
|
|
Xxxx
|
015019320
|
Area
3 Counties:
|
County
|
Provider
Number
|
|
Citrus
|
015019309
|
|
Lake
|
015019319
|
|
Xxxxxx
|
015019323
|
|
Xxxxxx
|
015019329
|
Area
4 Counties:
|
County
|
Provider
Number
|
|
Xxxxx
|
015019313
|
|
Volusia
|
015019335
|
Area
5 Counties:
|
County
|
Provider
Number
|
|
Pasco
|
015019302
|
|
Pinellas
|
015019303
|
Area
6 Counties:
|
County
|
Provider
Number
|
|
Highlands
|
015019317
|
|
Hillsborough
|
015019300
|
|
Manatee
|
015019301
|
|
Polk
|
015019304
|
AHCA
Contract No. FA619, Exhibit II-A, Page 1 of 2
AHCA
Form
2100-0002 (Rev. NOV03)
HealthEase
of Florida, Inc. Medicaid HMO Contract d/b/a HealthEase
Area
7 Counties:
|
County
|
Provider
Number
|
|
Brevard
|
015019308
|
|
Orange
|
015019327
|
|
Osceola
|
015019328
|
|
Seminole
|
015019333
|
Area
8 Counties:
|
County
|
Provider
Number
|
|
Sarasota
|
015019332
|
Area
9 Counties:
|
County
|
Provider
Number
|
|
Xxxxxx
|
015019324
|
|
Palm
Beach
|
015019339
|
Area
10 Counties:
|
County
|
Provider
Number
|
|
Broward
|
015019337
|
Area
11 Counties:
|
County
|
Provider
Number
|
|
Miami-Dade
|
015019338
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FA619, Exhibit II-A, Page 2 of
2
AHCA
Form 2100-0002 (Rev.
NOV03)
|
EXHIBIT
III-A
|
|||||||||||||||||||
|
September
1, 2007- August 31, 2008
|
|||||||||||||||||||
|
Medicaid
Non-Reform HMO Capitation Rates
|
|||||||||||||||||||
|
By
Area , Age and Eligibility Category
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY
CMS)
|
|||||||||||||||||||
|
TABLE
1
|
|||||||||||||||||||
|
General
Rates:
|
|||||||||||||||||||
|
XXXX
|
XXX-X
|
XXX-X
|
XXX-XX
|
||||||||||||||||
|
Xxxx
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
|
AGE
(65-)
|
AGE
(65+)
|
||
|
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||
|
01
|
1,131.99
|
202.30
|
105.58
|
66.22
|
135.19
|
72.29
|
265.45
|
167.89
|
347.47
|
10,081.87
|
1,458.88
|
435.95
|
201.26
|
222.08
|
716.10
|
703.88
|
271.50
|
138.14
|
112.37
|
|
02
|
1,131.99
|
202.30
|
105.58
|
66.22
|
135.19
|
72.29
|
265.45
|
167.89
|
347.47
|
10,081.87
|
1,458.88
|
435.95
|
201.26
|
222.08
|
716.10
|
703.88
|
271.50
|
138.14
|
112.37
|
|
03
|
1,296.42
|
233.58
|
122.13
|
77.48
|
156.47
|
84.50
|
308.68
|
196.24
|
408.68
|
11,326.29
|
1,656.79
|
495.12
|
233.33
|
256.55
|
826.59
|
816.63
|
273.34
|
129.66
|
105.80
|
|
04
|
1,128.87
|
203.75
|
106.78
|
67.92
|
136.68
|
74.01
|
269.88
|
171.79
|
358.59
|
10,675.98
|
1,563.58
|
467.86
|
220.87
|
242.36
|
781.86
|
772.10
|
330.41
|
133.72
|
109.08
|
|
05
|
1,260.50
|
227.66
|
119.09
|
75.94
|
152.59
|
82.61
|
301.42
|
191.81
|
400.30
|
11,774.49
|
1,721.01
|
514.94
|
241.96
|
266.53
|
857.42
|
846.21
|
230.22
|
127.48
|
104.72
|
|
06
|
1,111.64
|
201.87
|
106.04
|
68.10
|
135.60
|
74.02
|
269.07
|
171.81
|
360.32
|
10,832.05
|
1,590.31
|
475.95
|
225.91
|
247.84
|
799.09
|
790.01
|
284.19
|
124.63
|
101.81
|
|
07
|
1,129.81
|
204.44
|
107.10
|
68.40
|
137.11
|
74.43
|
271.08
|
172.77
|
361.05
|
11,163.75
|
1,640.70
|
490.80
|
233.68
|
256.10
|
824.52
|
815.86
|
327.20
|
128.73
|
105.41
|
|
08
|
1,059.95
|
192.36
|
100.83
|
64.75
|
129.15
|
70.40
|
255.88
|
163.25
|
342.35
|
9,491.26
|
1,388.78
|
415.62
|
196.24
|
215.38
|
694.16
|
685.42
|
192.02
|
118.95
|
97.25
|
|
09
|
1,098.82
|
197.96
|
103.63
|
65.91
|
132.56
|
71.62
|
261.85
|
166.57
|
346.99
|
10,597.24
|
1,556.56
|
465.60
|
221.41
|
242.54
|
781.98
|
773.10
|
205.98
|
127.97
|
104.76
|
|
10
|
1,119.46
|
203.01
|
106.51
|
68.32
|
136.20
|
74.23
|
270.06
|
172.18
|
360.84
|
13,743.01
|
2,028.53
|
606.68
|
290.75
|
319.15
|
1,026.77
|
1,016.73
|
256.37
|
143.41
|
117.45
|
|
11
|
1,448.96
|
260.41
|
136.24
|
86.18
|
174.38
|
94.02
|
343.72
|
218.26
|
453.77
|
14,396.52
|
2,111.55
|
631.62
|
299.15
|
329.01
|
1,058.44
|
1,046.51
|
336.08
|
198.00
|
160.77
|
|
TABLE
2
|
|||||||||||||||||||
|
General
+ Mental Health Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
||||||||||||||||
|
Area
|
BTHMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
|
|||||||||||||||
|
01
|
1,132.01
|
202.32
|
107.22
|
77.91
|
146.11
|
83.21
|
269.89
|
172.33
|
351.22
|
10,081.95
|
1,458.96
|
443.39
|
249.30
|
266.06
|
797.48
|
734.86
|
271.71
|
149.79
|
124.02
|
|
02
|
1,132.02
|
202.33
|
108.49
|
86.47
|
148.60
|
85.70
|
268.86
|
171.30
|
350.43
|
10,082.03
|
1,459.04
|
449.74
|
280.06
|
267.29
|
768.77
|
728.75
|
291.70
|
153.14
|
127.37
|
|
03
|
1,296.43
|
233.59
|
123.45
|
86.66
|
162.55
|
90.58
|
310.23
|
197.79
|
410.02
|
11,326.36
|
1,656.86
|
501.38
|
269.08
|
277.06
|
850.48
|
827.91
|
280.19
|
138.64
|
114.78
|
|
04
|
1,128.88
|
203.76
|
108.15
|
77.48
|
143.01
|
80.34
|
271.49
|
173.40
|
359.98
|
10,676.09
|
1,563.69
|
477.61
|
276.60
|
274.33
|
819.11
|
789.69
|
354.96
|
150.49
|
125.85
|
|
05
|
1,260.51
|
227.67
|
120.30
|
84.61
|
160.70
|
90.72
|
304.71
|
195.10
|
403.08
|
11,774.54
|
1,721.06
|
519.96
|
274.37
|
296.20
|
912.32
|
867.11
|
232.95
|
140.29
|
117.53
|
|
06
|
1,111.66
|
201.89
|
107.89
|
81.34
|
147.98
|
86.40
|
274.10
|
176.84
|
364.57
|
10,832.12
|
1,590.38
|
482.47
|
268.01
|
286.38
|
870.40
|
817.15
|
285.50
|
128.51
|
105.69
|
|
07
|
1,129.83
|
204.46
|
108.88
|
81.08
|
148.96
|
86.28
|
275.90
|
177.59
|
365.12
|
11,163.81
|
1,640.76
|
496.92
|
273.18
|
292.26
|
891.44
|
841.33
|
329.79
|
139.24
|
115.92
|
|
08
|
1,059.96
|
192.37
|
102.09
|
73.55
|
134.98
|
76.23
|
257.36
|
164.73
|
343.63
|
9,491.33
|
1,388.85
|
421.62
|
230.52
|
235.05
|
717.07
|
696.24
|
198.87
|
132.17
|
110.47
|
|
09
|
1,098.84
|
197.98
|
105.18
|
76.72
|
139.72
|
78.78
|
263.67
|
168.39
|
348.57
|
10,597.31
|
1,556.63
|
471.93
|
257.55
|
263.28
|
806.13
|
784.51
|
212.83
|
137.56
|
114.35
|
|
10
|
1,119.48
|
203.03
|
108.43
|
81.68
|
145.05
|
83.08
|
272.31
|
174.43
|
362.79
|
13,743.10
|
2,028.62
|
615.03
|
338.45
|
346.52
|
1,058.65
|
1,031.78
|
263.22
|
151.46
|
125.50
|
|
11
|
1,448.98
|
260.43
|
137.86
|
97.47
|
181.86
|
101.50
|
345.62
|
220.16
|
455.42
|
14,396.60
|
2,111.63
|
638.59
|
338.94
|
351.84
|
1,085.04
|
1,059.07
|
343.31
|
206.05
|
168.82
|
|
TABLE
3
|
|||||||||||||||||||
|
General
+ MH + Dental Rates:
|
|||||||||||||||||||
|
XXXX
|
XXX-X
|
XXX-X
|
XXX-XX
|
||||||||||||||||
|
Xxxx
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,132.02
|
202.33
|
109.31
|
82.23
|
150.59
|
86.99
|
271.74
|
173.97
|
354.63
|
10,081.95
|
1,458.97
|
445.59
|
253.12
|
269.40
|
800.35
|
738.28
|
272.21
|
152.10
|
125.50
|
|
02
|
1,132.03
|
202.34
|
110.58
|
90.79
|
153.08
|
89.48
|
270.71
|
172.94
|
353.84
|
10,082.03
|
1,459.05
|
451.94
|
283.88
|
270.63
|
771.64
|
732.17
|
292.20
|
155.45
|
128.85
|
|
03
|
1,296.44
|
233.60
|
126.52
|
93.00
|
169.14
|
96.13
|
313.24
|
200.46
|
415.57
|
11,326.37
|
1,656.88
|
504.76
|
274.93
|
282.17
|
854.04
|
832.15
|
280.73
|
141.72
|
116.76
|
|
04
|
1,128.89
|
203.77
|
110.20
|
81.71
|
147.39
|
84.03
|
274.30
|
175.89
|
365.17
|
10,676.09
|
1,563.70
|
479.82
|
280.43
|
277.68
|
822.42
|
793.64
|
356.97
|
153.57
|
127.83
|
|
05
|
1,260.52
|
227.69
|
123.77
|
91.76
|
168.12
|
96.98
|
311.90
|
201.49
|
416.36
|
11,774.55
|
1,721.08
|
524.88
|
282.89
|
303.65
|
919.87
|
876.10
|
237.38
|
148.63
|
122.88
|
|
06
|
1,111.67
|
201.90
|
110.53
|
86.79
|
153.63
|
91.17
|
277.72
|
180.05
|
371.26
|
10,832.13
|
1,590.40
|
485.64
|
273.51
|
291.19
|
874.82
|
822.42
|
287.34
|
133.29
|
108.76
|
|
07
|
1,129.84
|
204.47
|
111.04
|
85.54
|
153.58
|
90.17
|
278.43
|
179.84
|
369.79
|
11,163.81
|
1,640.77
|
500.03
|
278.58
|
296.97
|
894.55
|
845.04
|
331.41
|
142.40
|
117.95
|
|
08
|
1,059.97
|
192.38
|
105.11
|
79.80
|
141.46
|
81.69
|
260.37
|
167.40
|
349.19
|
9,491.34
|
1,388.87
|
424.74
|
235.93
|
239.77
|
720.67
|
700.54
|
200.35
|
135.32
|
112.48
|
|
09
|
1,098.85
|
197.99
|
108.10
|
82.75
|
145.98
|
84.06
|
265.42
|
169.94
|
351.80
|
10,597.31
|
1,556.64
|
474.66
|
262.28
|
267.41
|
807.81
|
786.52
|
213.56
|
139.40
|
115.53
|
|
10
|
1,119.49
|
203.04
|
111.29
|
87.56
|
151.15
|
88.23
|
274.13
|
176.05
|
366.16
|
13,743.11
|
2,028.64
|
618.77
|
344.93
|
352.19
|
1,060.76
|
1,034.30
|
265.27
|
154.03
|
127.15
|
|
11
|
1,448.99
|
260.44
|
141.58
|
105.13
|
189.81
|
108.20
|
347.23
|
221.59
|
458.40
|
14,396.61
|
2,111.65
|
642.83
|
346.28
|
358.26
|
1,088.67
|
1,063.40
|
347.71
|
210.11
|
171.42
|
|
TABLE
4
|
|||||||||||||||||||
|
General
+ MH + Transportation Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
||||||||||||||||
|
Area
|
BTHMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
|
|||||||||||||||
|
01
|
1,137.56
|
203.71
|
108.08
|
78.43
|
148.03
|
84.47
|
272.98
|
174.71
|
354.40
|
10,125.36
|
1,486.99
|
449.03
|
251.78
|
272.18
|
817.47
|
751.37
|
278.48
|
163.52
|
132.78
|
|
02
|
1,137.57
|
203.72
|
109.35
|
86.99
|
150.52
|
86.96
|
271.95
|
173.68
|
353.61
|
10,125.44
|
1,487.07
|
455.38
|
282.54
|
273.41
|
788.76
|
745.26
|
298.47
|
166.87
|
136.13
|
|
03
|
1,303.13
|
235.26
|
124.49
|
87.29
|
164.87
|
92.09
|
313.95
|
200.67
|
413.86
|
11,381.17
|
1,692.25
|
508.50
|
272.20
|
284.79
|
875.73
|
848.76
|
288.81
|
158.48
|
127.44
|
|
04
|
1,133.91
|
205.01
|
108.93
|
77.95
|
144.75
|
81.48
|
274.28
|
175.56
|
362.87
|
10,720.46
|
1,592.34
|
483.38
|
279.13
|
280.59
|
839.55
|
806.56
|
361.93
|
166.27
|
135.91
|
|
05
|
1,264.71
|
228.72
|
120.95
|
85.01
|
162.15
|
91.67
|
307.04
|
196.90
|
405.49
|
11,809.84
|
1,743.85
|
524.54
|
276.38
|
301.18
|
928.58
|
880.53
|
238.83
|
154.32
|
126.48
|
|
06
|
1,115.71
|
202.90
|
108.52
|
81.72
|
149.38
|
87.31
|
276.35
|
178.58
|
366.89
|
10,866.95
|
1,612.87
|
487.00
|
270.00
|
291.30
|
886.44
|
830.40
|
290.82
|
140.11
|
113.09
|
|
07
|
1,133.77
|
205.44
|
109.49
|
81.45
|
150.32
|
87.17
|
278.09
|
179.28
|
367.38
|
11,201.13
|
1,664.85
|
501.77
|
275.30
|
297.53
|
908.63
|
855.51
|
335.43
|
151.37
|
123.67
|
|
08
|
1,065.54
|
193.77
|
102.95
|
74.07
|
136.91
|
77.49
|
260.46
|
167.12
|
346.83
|
9,532.67
|
1,415.54
|
427.00
|
232.88
|
240.88
|
736.11
|
711.96
|
204.95
|
146.97
|
119.92
|
|
09
|
1,104.22
|
199.32
|
106.02
|
77.23
|
141.58
|
79.99
|
266.66
|
170.70
|
351.65
|
10,640.50
|
1,584.51
|
477.55
|
260.02
|
269.38
|
826.01
|
800.93
|
219.75
|
153.37
|
124.43
|
|
10
|
1,123.27
|
203.97
|
109.01
|
82.04
|
146.35
|
83.94
|
274.42
|
176.05
|
364.96
|
13,782.23
|
2,053.89
|
620.11
|
340.69
|
352.05
|
1,076.67
|
1,046.66
|
270.52
|
169.12
|
136.76
|
|
11
|
1,452.24
|
261.24
|
138.36
|
97.78
|
182.98
|
102.24
|
347.43
|
221.56
|
457.29
|
14,425.98
|
2,130.60
|
642.40
|
340.62
|
355.99
|
1,098.57
|
1,070.25
|
348.23
|
218.56
|
176.80
|
|
TABLE
5
|
|||||||||||||||||||
|
General
+ Transportation Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
||||||||||||||||
|
Area
|
BTHMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,137.54
|
203.69
|
106.44
|
66.74
|
137.11
|
73.55
|
268.54
|
170.27
|
350.65
|
10,125.28
|
1,486.91
|
441.59
|
203.74
|
228.20
|
736.09
|
720.39
|
278.27
|
151.87
|
121.13
|
|
02
|
1,137.54
|
203.69
|
106.44
|
66.74
|
137.11
|
73.55
|
268.54
|
170.27
|
350.65
|
10,125.28
|
1,486.91
|
441.59
|
203.74
|
228.20
|
736.09
|
720.39
|
278.27
|
151.87
|
121.13
|
|
03
|
1,303.12
|
235.25
|
123.17
|
78.11
|
158.79
|
86.01
|
312.40
|
199.12
|
412.52
|
11,381.10
|
1,692.18
|
502.24
|
236.45
|
264.28
|
851.84
|
837.48
|
281.96
|
149.50
|
118.46
|
|
04
|
1,133.90
|
205.00
|
107.56
|
68.39
|
138.42
|
75.15
|
272.67
|
173.95
|
361.48
|
10,720.35
|
1,592.23
|
473.63
|
223.40
|
248.62
|
802.30
|
788.97
|
337.38
|
149.50
|
119.14
|
|
05
|
1,264.70
|
228.71
|
119.74
|
76.34
|
154.04
|
83.56
|
303.75
|
193.61
|
402.71
|
11,809.79
|
1,743.80
|
519.52
|
243.97
|
271.51
|
873.68
|
859.63
|
236.10
|
141.51
|
113.67
|
|
06
|
1,115.69
|
202.88
|
106.67
|
68.48
|
137.00
|
74.93
|
271.32
|
173.55
|
362.64
|
10,866.88
|
1,612.80
|
480.48
|
227.90
|
252.76
|
815.13
|
803.26
|
289.51
|
136.23
|
109.21
|
|
07
|
1,133.75
|
205.42
|
107.71
|
68.77
|
138.47
|
75.32
|
273.27
|
174.46
|
363.31
|
11,201.07
|
1,664.79
|
495.65
|
235.80
|
261.37
|
841.71
|
830.04
|
332.84
|
140.86
|
113.16
|
|
08
|
1,065.53
|
193.76
|
101.69
|
65.27
|
131.08
|
71.66
|
258.98
|
165.64
|
345.55
|
9,532.60
|
1,415.47
|
421.00
|
198.60
|
221.21
|
713.20
|
701.14
|
198.10
|
133.75
|
106.70
|
|
09
|
1,104.20
|
199.30
|
104.47
|
66.42
|
134.42
|
72.83
|
264.84
|
168.88
|
350.07
|
10,640.43
|
1,584.44
|
471.22
|
223.88
|
248.64
|
801.86
|
789.52
|
212.90
|
143.78
|
114.84
|
|
10
|
1,123.25
|
203.95
|
107.09
|
68.68
|
137.50
|
75.09
|
272.17
|
173.80
|
363.01
|
13,782.14
|
2,053.80
|
611.76
|
292.99
|
324.68
|
1,044.79
|
1,031.61
|
263.67
|
161.07
|
128.71
|
|
11
|
1,452.22
|
261.22
|
136.74
|
86.49
|
175.50
|
94.76
|
345.53
|
219.66
|
455.64
|
14,425.90
|
2,130.52
|
635.43
|
300.83
|
333.16
|
1,071.97
|
1,057.69
|
341.00
|
210.51
|
168.75
|
|
TABLE
6
|
|||||||||||||||||||
|
General
+ Dental Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
||||||||||||||||
|
Area
|
BTHMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,132.00
|
202.31
|
107.67
|
70.54
|
139.67
|
76.07
|
267.30
|
169.53
|
350.88
|
10,081.87
|
1,458.89
|
438.15
|
205.08
|
225.42
|
718.97
|
707.30
|
272.00
|
140.45
|
113.85
|
|
02
|
1,132.00
|
202.31
|
107.67
|
70.54
|
139.67
|
76.07
|
267.30
|
169.53
|
350.88
|
10,081.87
|
1,458.89
|
438.15
|
205.08
|
225.42
|
718.97
|
707.30
|
272.00
|
140.45
|
113.85
|
|
03
|
1,296.43
|
233.59
|
125.20
|
83.82
|
163.06
|
90.05
|
311.69
|
198.91
|
414.23
|
11,326.30
|
1,656.81
|
498.50
|
239.18
|
261.66
|
830.15
|
820.87
|
273.88
|
132.74
|
107.78
|
|
04
|
1,128.88
|
203.76
|
108.83
|
72.15
|
141.06
|
77.70
|
272.69
|
174.28
|
363.78
|
10,675.98
|
1,563.59
|
470.07
|
224.70
|
245.71
|
785.17
|
776.05
|
332.42
|
136.80
|
111.06
|
|
05
|
1,260.51
|
227.68
|
122.56
|
83.09
|
160.01
|
88.87
|
308.61
|
198.20
|
413.58
|
11,774.50
|
1,721.03
|
519.86
|
250.48
|
273.98
|
864.97
|
855.20
|
234.65
|
135.82
|
110.07
|
|
06
|
1,111.65
|
201.88
|
108.68
|
73.55
|
141.25
|
78.79
|
272.69
|
175.02
|
367.01
|
10,832.06
|
1,590.33
|
479.12
|
231.41
|
252.65
|
803.51
|
795.28
|
286.03
|
129.41
|
104.88
|
|
07
|
1,129.82
|
204.45
|
109.26
|
72.86
|
141.73
|
78.32
|
273.61
|
175.02
|
365.72
|
11,163.75
|
1,640.71
|
493.91
|
239.08
|
260.81
|
827.63
|
819.57
|
328.82
|
131.89
|
107.44
|
|
08
|
1,059.96
|
192.37
|
103.85
|
71.00
|
135.63
|
75.86
|
258.89
|
165.92
|
347.91
|
9,491.27
|
1,388.80
|
418.74
|
201.65
|
220.10
|
697.76
|
689.72
|
193.50
|
122.10
|
99.26
|
|
09
|
1,098.83
|
197.97
|
106.55
|
71.94
|
138.82
|
76.90
|
263.60
|
168.12
|
350.22
|
10,597.24
|
1,556.57
|
468.33
|
226.14
|
246.67
|
783.66
|
775.11
|
206.71
|
129.81
|
105.94
|
|
10
|
1,119.47
|
203.02
|
109.37
|
74.20
|
142.30
|
79.38
|
271.88
|
173.80
|
364.21
|
13,743.02
|
2,028.55
|
610.42
|
297.23
|
324.82
|
1,028.88
|
1,019.25
|
258.42
|
145.98
|
119.10
|
|
11
|
1,448.97
|
260.42
|
139.96
|
93.84
|
182.33
|
100.72
|
345.33
|
219.69
|
456.75
|
14,396.53
|
2,111.57
|
635.86
|
306.49
|
335.43
|
1,062.07
|
1,050.84
|
340.48
|
202.06
|
163.37
|
|
TABLE
7
|
|||||||||||||||||||
|
General
+ Dental + Transportation Rates:
|
|||||||||||||||||||
|
XXXX
|
XXX-X
|
XXX-X
|
XXX-XX
|
||||||||||||||||
|
Xxxx
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
|
|||||||||||||||
|
01
|
1,137.55
|
203.70
|
108.53
|
71.06
|
141.59
|
77.33
|
270.39
|
171.91
|
354.06
|
10,125.28
|
1,486.92
|
443.79
|
207.56
|
231.54
|
738.96
|
723.81
|
278.77
|
154.18
|
122.61
|
|
02
|
1,137.55
|
203.70
|
108.53
|
71.06
|
141.59
|
77.33
|
270.39
|
171.91
|
354.06
|
10,125.28
|
1,486.92
|
443.79
|
207.56
|
231.54
|
738.96
|
723.81
|
278.77
|
154.18
|
122.61
|
|
03
|
1,303.13
|
235.26
|
126.24
|
84.45
|
165.38
|
91.56
|
315.41
|
201.79
|
418.07
|
11,381.11
|
1,692.20
|
505.62
|
242.30
|
269.39
|
855.40
|
841.72
|
282.50
|
152.58
|
120.44
|
|
04
|
1,133.91
|
205.01
|
109.61
|
72.62
|
142.80
|
78.84
|
275.48
|
176.44
|
366.67
|
10,720.35
|
1,592.24
|
475.84
|
227.23
|
251.97
|
805.61
|
792.92
|
339.39
|
152.58
|
121.12
|
|
05
|
1,264.71
|
228.73
|
123.21
|
83.49
|
161.46
|
89.82
|
310.94
|
200.00
|
415.99
|
11,809.80
|
1,743.82
|
524.44
|
252.49
|
278.96
|
881.23
|
868.62
|
240.53
|
149.85
|
119.02
|
|
06
|
1,115.70
|
202.89
|
109.31
|
73.93
|
142.65
|
79.70
|
274.94
|
176.76
|
369.33
|
10,866.89
|
1,612.82
|
483.65
|
233.40
|
257.57
|
819.55
|
808.53
|
291.35
|
141.01
|
112.28
|
|
07
|
1,133.76
|
205.43
|
109.87
|
73.23
|
143.09
|
79.21
|
275.80
|
176.71
|
367.98
|
11,201.07
|
1,664.80
|
498.76
|
241.20
|
266.08
|
844.82
|
833.75
|
334.46
|
144.02
|
115.19
|
|
08
|
1,065.54
|
193.77
|
104.71
|
71.52
|
137.56
|
77.12
|
261.99
|
168.31
|
351.11
|
9,532.61
|
1,415.49
|
424.12
|
204.01
|
225.93
|
716.80
|
705.44
|
199.58
|
136.90
|
108.71
|
|
09
|
1,104.21
|
199.31
|
107.39
|
72.45
|
140.68
|
78.11
|
266.59
|
170.43
|
353.30
|
10,640.43
|
1,584.45
|
473.95
|
228.61
|
252.77
|
803.54
|
791.53
|
213.63
|
145.62
|
116.02
|
|
10
|
1,123.26
|
203.96
|
109.95
|
74.56
|
143.60
|
80.24
|
273.99
|
175.42
|
366.38
|
13,782.15
|
2,053.82
|
615.50
|
299.47
|
330.35
|
1,046.90
|
1,034.13
|
265.72
|
163.64
|
130.36
|
|
11
|
1,452.23
|
261.23
|
140.46
|
94.15
|
183.45
|
101.46
|
347.14
|
221.09
|
458.62
|
14,425.91
|
2,130.54
|
639.67
|
308.17
|
339.58
|
1,075.60
|
1,062.02
|
345.40
|
214.57
|
171.35
|
|
TABLE
8
|
|||||||||||||||||||
|
General
+ Mental Health + Dental + Transportation Rates:
|
|||||||||||||||||||
|
XXXX
|
XXX-X
|
XXX-X
|
XXX-XX
|
||||||||||||||||
|
Xxxx
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,137.57
|
203.72
|
110.17
|
82.75
|
152.51
|
88.25
|
274.83
|
176.35
|
357.81
|
10,125.36
|
1,487.00
|
451.23
|
255.60
|
275.52
|
820.34
|
754.79
|
278.98
|
165.83
|
134.26
|
|
02
|
1,137.58
|
203.73
|
111.44
|
91.31
|
155.00
|
90.74
|
273.80
|
175.32
|
357.02
|
10,125.44
|
1,487.08
|
457.58
|
286.36
|
276.75
|
791.63
|
748.68
|
298.97
|
169.18
|
137.61
|
|
03
|
1,303.14
|
235.27
|
127.56
|
93.63
|
171.46
|
97.64
|
316.96
|
203.34
|
419.41
|
11,381.18
|
1,692.27
|
511.88
|
278.05
|
289.90
|
879.29
|
853.00
|
289.35
|
161.56
|
129.42
|
|
04
|
1,133.92
|
205.02
|
110.98
|
82.18
|
149.13
|
85.17
|
277.09
|
178.05
|
368.06
|
10,720.46
|
1,592.35
|
485.59
|
282.96
|
283.94
|
842.86
|
810.51
|
363.94
|
169.35
|
137.89
|
|
05
|
1,264.72
|
228.74
|
124.42
|
92.16
|
169.57
|
97.93
|
314.23
|
203.29
|
418.77
|
11,809.85
|
1,743.87
|
529.46
|
284.90
|
308.63
|
936.13
|
889.52
|
243.26
|
162.66
|
131.83
|
|
06
|
1,115.72
|
202.91
|
111.16
|
87.17
|
155.03
|
92.08
|
279.97
|
181.79
|
373.58
|
10,866.96
|
1,612.89
|
490.17
|
275.50
|
296.11
|
890.86
|
835.67
|
292.66
|
144.89
|
116.16
|
|
07
|
1,133.78
|
205.45
|
111.65
|
85.91
|
154.94
|
91.06
|
280.62
|
181.53
|
372.05
|
11,201.13
|
1,664.86
|
504.88
|
280.70
|
302.24
|
911.74
|
859.22
|
337.05
|
154.53
|
125.70
|
|
08
|
1,065.55
|
193.78
|
105.97
|
80.32
|
143.39
|
82.95
|
263.47
|
169.79
|
352.39
|
9,532.68
|
1,415.56
|
430.12
|
238.29
|
245.60
|
739.71
|
716.26
|
206.43
|
150.12
|
121.93
|
|
09
|
1,104.23
|
199.33
|
108.94
|
83.26
|
147.84
|
85.27
|
268.41
|
172.25
|
354.88
|
10,640.50
|
1,584.52
|
480.28
|
264.75
|
273.51
|
827.69
|
802.94
|
220.48
|
155.21
|
125.61
|
|
10
|
1,123.28
|
203.98
|
111.87
|
87.92
|
152.45
|
89.09
|
276.24
|
177.67
|
368.33
|
13,782.24
|
2,053.91
|
623.85
|
347.17
|
357.72
|
1,078.78
|
1,049.18
|
272.57
|
171.69
|
138.41
|
|
11
|
1,452.25
|
261.25
|
142.08
|
105.44
|
190.93
|
108.94
|
349.04
|
222.99
|
460.27
|
14,425.99
|
2,130.62
|
646.64
|
347.96
|
362.41
|
1,102.20
|
1,074.58
|
352.63
|
222.62
|
179.40
|
|
Area
|
Corresponding
Counties
|
||||||||||||||||||
|
Area
1
|
Escambia,
Okaloosa, Santa Rosa, Walton
|
||||||||||||||||||
|
Area
2
|
Bay,
Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Xxxxxxxxx, Xxxx,
Liberty, Madison, Taylor, Washington, Wakulla
|
||||||||||||||||||
|
Area
3
|
Alachua,
Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamiliton, Hernando,
Lafayette, Lake, Xxxx, Xxxxxx, Putnam, Sumter, Suwannee, Union
|
||||||||||||||||||
|
Area
4
|
Baker,
Clay, Duval, Flagler, Nassau, St. Xxxxx, Volusia
|
||||||||||||||||||
|
Area
5
|
Pasco,
Pinellas
|
||||||||||||||||||
|
Area
6
|
Xxxxxx,
Highlands, Hillsborough, Manatee, Polk
|
||||||||||||||||||
|
Area
7
|
Brevard,
Orange, Osceola, Seminole
|
||||||||||||||||||
|
Area
8
|
Charlotte,
Xxxxxxx, De Xxxx, Glades, Hendry, Lee, Sarasota
|
||||||||||||||||||
|
Area
9
|
Indian
River, Okeechobee, St. Lucie, Martin, Palm Beach
|
||||||||||||||||||
|
Area
10
|
Broward
|
||||||||||||||||||
|
Area
11
|
Dade,
Monroe
|
||||||||||||||||||
|
Created
on August 10, 2007
|
|||||||||||||||||||
