AHCA CONTRACT NO. FA615
Exhibit
10.2
AMENDMENT
NO. 2
THIS
CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and
WELLCARE OF FLORIDA, INC. D/B/A STAYWELL HEALTH PLAN OF FLORIDA,
hereinafter referred to as the "Vendor" or “Health Plan”, is hereby
amended as follows:
|
1.
|
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
|
|
|
WellCare
of Florida, Inc. d/b/a Staywell Health Plan of
Florida
|
|
|
0000
Xxxxxxxxx Xxxx
|
|
|
Xxxxx,
XX 00000-0000
|
| (000) 000-0000 |
|
2.
|
Attachment
I, Scope of Services, is hereby amended to include Exhibit II-B,
Second
Revised Capitation Rates, attached hereto and made a part of the
Contract. All references in the Contract to Exhibit II-A,
Revised Capitation Rates, shall hereinafter also refer to Exhibit
II-B,
Second Revised Capitation Rates, as
appropriate.
|
|
3.
|
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.
|
|
4.
|
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.
|
|
5.
|
This
Amendment shall have an effective date of September 1, 2007, or the
date
on which both parties
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 eight (8) page Amendment (which includes all attachments
hereto) to be executed by their officials thereunto duly
authorized.
|
WELLCARE
OF FLORIDA, INC. D/B/A STAYWELL HEALTH PLAN 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-B
|
Second
Revised Capitation Rates (1 Page)
|
|
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. FA615, Amendment No. 2, Page 2 of
2
AHCA
Form
2100-0002 (Rev. NOV03)
Wellcare
of Florida, Inc. Medicaid HMO Contract
d/b/a
Staywell Health Plan of Florida
EXHIBIT
II-B
SECOND
REVISED CAPITATION RATES
|
|
A.
|
Table
4 - General Capitation Rates plus Mental Health Rates plus
Transportation:
|
Area
3 Counties:
|
County
|
Provider
Number
|
|
Hernando
|
015016901
|
|
Sumter
|
015016916
|
Area
5 Counties:
|
County
|
Provider
Number
|
|
Pasco
|
015016903
|
|
Pinellas
|
015016904
|
Area
6 Counties:
|
County
|
Provider
Number
|
|
Hillsborough
|
015016902
|
|
Manatee
|
015016912
|
|
Polk
|
015016905
|
Area
7 Counties:
|
County
|
Provider
Number
|
|
Orange
|
015016906
|
|
Seminole
|
015016908
|
|
Osceola
|
015016907
|
|
Xxxxxxx
|
000000000
|
Xxxx
0 Xxxxxxxx:
|
Xxxxxx
|
Provider
Number
|
|
Xxx
|
015016911
|
|
Sarasota
|
015016914
|
Area
9 Counties:
|
County
|
Provider
Number
|
|
Palm
Beach
|
015016910
|
|
St.
Lucie
|
015016915
|
Area
10 Counties:
|
County
|
Provider
Number
|
|
Broward
|
015016900
|
Area
11 Counties:
|
County
|
Provider
Number
|
|
Miami-Dade
|
015016909
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
|
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
|
||||||||||||||||||||
