EX-10.1






Amerigroup Florida, Inc. Medicaid HMO Contract d/b/a Amerigroup Community Care



AHCA CONTRACT NO. FA614




AMENDMENT NO. 7




THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,
hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC. D/B/A AMERIGROUP COMMUNITY
CARE, hereinafter referred to as the “Vendor” or “Health Plan”, is hereby amended as follows:




	1.	 	Standard Contract, Section II, Item A, Contract Amount, the first sentence is hereby
revised to now read as follows:






To pay for contracted services according to the conditions of Attachment I in an amount not
to exceed $1,016,426,981.00 (a decrease of $66,372,500.00), subject to availability of
funds.




	2.	 	Attachment I, Section B, Method of Payment, Item 1, General, the first paragraph is hereby
revised now to read as follows:






Notwithstanding the payment amounts which may be computed with the rate tables specified in
Exhibit III-C, the sum total capitation payments under this Contract shall not exceed the
total Contract amount of $1,016,426,981.00 (a decrease of $66,372,500.00).




	3.	 	Attachment 1, Scope of Services, is hereby amended to include Exhibit III-C, January 1, 2008
– 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-B, September 1, 2007 – August 31,
2008 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter instead refer to Exhibit
III-C, January 1, 2008 – August 31, 2008 Medicaid Non-Reform HMO Capitation Rates.






	4.	 	This Amendment shall have an effective date of January 1, 2008, or the date, in 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.



THE REMAINDER OF PAGE INTENTIONALLY LEFT BLANK




AHCA Contract No. FA614, Amendment No. 7, Page 1 of 2




Amerigroup Florida, Inc. Medicaid HMO Contract



d/b/a Amerigroup Community Care



IN WITNESS WHEREOF, the parties hereto have caused this seven (7) page Amendment (which
includes all attachments hereto) to be executed by their officials thereunto duly authorized.



	 	 	 	 	 
	AMERIGROUP FLORIDA, INC.STATE OF FLORIDA, AGENCY FOR
	D/B/A/ AMERIGROUP COMMUNITY CAREHEALTH CARE ADMINISTRATION
	SIGNED

BY:

	 	 	 	SIGNED

BY:
	NAME:Thomas Wilfong .......................
	 	NAME:Andrew C. Agwunobi, M.D
	 
	 	 
	TITLE: COO

	 	 	 	TITLE:Secretary
	 

	 	 	 	 
	DATE: 12/28/07 ...........................
	 	DATE:
	List of attachments included as part of this Amendment:

	Specify

Type

	 	Letter/Number

        .............
	 	

Description
	 

	 	 
	 	 
	Exhibit

	 	III-C
	 	January 1, 2008- August 31, 2008 Medicaid Non-Reform HMO






Capitation Rates (5 Pages)



AHCA Contract No. FA614, Amendment No. 7, Page 2 of 3




1





AHCA Contract No. FA614, Exhibit III-C, Page 1
of 5



EXHIBIT III-C

January 1, 2008- 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:

	 	

	 	

	 	

	 	

	
 
	 	TANF
	 	SSI-N
	 	SSI-B
	 	SSI-AB






Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO
AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	011,113.27198.95

021,113.27198.95

31,274.97229.73

041,110.20200.37

051,239.65223.90

061,093.25198.54

071,111.11201.05

081,042.42189.18

091,080.64194.68

101,100.94199.64

111,424.99256.12

	 	103.84

103.84

120.11

105.01

117.11

104.28

105.33

99.15

101.92

104.76

134.00
	 	65.12

65.12

76.19

66.79

74.70

66.96

67.26

63.67

64.82

67.19

84.75
	 	132.96

132.96

153.87

134.42

150.07

133.36

134.84

127.01

130.37

133.94

171.50
	 	71.10

71.10

83.11

72.81

81.25

72.80

73.19

69.25

70.43

73.01

92.47
	 	261.06

261.06

303.58

265.41

296.43

264.61

266.60

251.65

257.53

265.61

338.04
	 	165.11

165.11

192.99

168.95

188.63

168.97

169.92

160.56

163.82

169.34

214.66
	 	341.74

341.74

401.92

352.65

393.68

354.37

355.07

336.69

341.26

354.88

446.26
	 	9,915.13

9,915.13

11,138.97

10,499.42

11,579.76

10,652.91

10,979.12

9,334.29

10,421.98

13,515.72

14,158.43
	 	1,434.75

1,434.75

1,629.39

1,537.71

1,692.54

1,564.02

1,613.56

1,365.81

1,530.82

1,994.98

2,076.63
	 	428.74

428.74

486.94

460.11

506.42

468.08

482.68

408.73

457.89

596.62

621.17
	 	197.94

197.94

229.48

217.21

237.96

222.16

229.82

192.99

217.75

285.93

294.21
	 	218.40

218.40

252.31

238.35

262.13

243.74

251.86

211.83

238.53

313.86

323.57
	 	704.25

704.25

812.92

768.93

843.24

785.88

810.88

682.67

769.06

1,009.75

1,040.93
	 	692.24

692.24

803.12

759.32

832.21

776.94

802.37

674.08

760.32

999.91

1,029.21
	 	266.36

266.36

268.11

324.10

224.84

278.82

320.94

187.79

201.31

251.29

329.75
	 	96.6779.38

96.6779.38

89.8974.16

92.6376.37

86.9172.45

84.0369.54

87.4479.54

83.0268.67

90.2874.77

103.3285.56

157.24128.37
	TABLE 2

General + Mental Health Rates:

	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	
 
	 	 	 	 	 	TANF
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N
	 	 	 	 	 	 	 	SSI-B
	 	SSI-AB






Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO
AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01

02

03

04

05

06

07

08

09

10

11

	 	1,113.29

1,113.30

1,274.98

1,110.21

1,239.66

1,093.27

1,111.13

1,042.43

1,080.66

1,100.96

1,425.01
	 	198.97

198.98

229.74

200.38

223.91

198.56

201.07

189.19

194.70

199.66

256.14
	 	105.45

106.70

121.41

106.36

118.30

106.10

107.08

100.39

103.44

106.65

135.59
	 	76.61

85.04

85.22

76.19

83.23

79.99

79.74

72.32

75.45

80.33

95.85
	 	143.70

146.15

159.85

140.65

158.04

145.53

146.50

132.74

137.41

142.64

178.86
	 	81.84

84.29

89.09

79.04

89.22

84.97

84.85

74.98

77.47

81.71

99.83
	 	265.43

264.41

305.10

266.99

299.67

269.56

271.34

253.11

259.32

267.82

339.91
	 	169.48

168.46

194.51

170.53

191.87

173.92

174.56

162.02

165.61

171.55

216.53
	 	345.42

344.65

403.24

354.02

396.42

358.55

359.07

337.96

342.81

356.80

447.88
	 	9,915.21

9,915.29

11,139.04

10,499.53

11,579.81

10,652.98

10,979.18

9,334.36

10,422.05

13,515.81

14,158.51
	 	1,434.83

1,434.91

1,629.46

1,537.82

1,692.59

1,564.09

1,613.62

1,365.88

1,995.07

1,995.07

2,076.71
	 	436.06

442.30

493.10

469.70

511.36

474.49

488.70

414.63

604.83

604.83

628.03
	 	245.19

275.44

264.64

272.02

269.84

263.57

268.67

226.70

338.45

322.84

333.34
	 	261.65

262.86

272.48

269.84

291.31

281.64

287.42

231.18

258.93

340.78

346.02
	 	784.29

756.05

836.42

805.57

897.24

856.02

876.69

705.20

792.81

1,041.14

1,067.09
	 	722.71

716.70

814.21

776.62

852.76

803.63

827.42

684.72

771.54

1,014.71

1,041.56
	 	266.57

286.23

274.85

348.24

227.52

280.11

323.49

194.53

208.05

258.03

336.86
	 	108.13

111.42

98.72

109.12

99.51

87.85

97.78

96.02

99.71

111.24

165.16
	 	90.84

94.13

82.99

92.86

85.05

73.36

82.88

81.67

84.20

93.47

136.29






2





AHCA Contract No. FA614, Exhibit III-C, Page 2
of 5



EXHIBIT III-C




January 1, 2008- 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 3	 	 	 	 	 	 
	General + MH + Dental Rates:

	 	

	 	

	 	

	TANF

	 	SSI-N
	 	SSI-B
	 	SSI-AB






Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO
AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	011,113.30198.98107.51

021,113.31198.99108.76

031,274.99229.75124.44

041,110.22200.39108.37

051,239.67223.93121.70

061,093.28198.57108.70

071,111.14201.08109.20

081,042.44189.20103.37

091,080.67194.71106.32

101,100.97199.67109.45

111,425.02256.15139.41

	 	80.86

89.29

91.46

80.34

90.26

85.35

84.12

78.47

81.39

86.12

103.51
	 	148.10

150.55

166.32

144.96

165.34

151.09

151.04

139.11

143.57

148.64

186.81
	 	85.55

88.00

94.55

82.68

95.37

89.66

88.68

80.35

82.66

86.77

106.53
	 	267.24

266.22

308.06

269.75

306.75

273.12

273.83

256.08

261.04

269.62

341.50
	 	171.09

170.07

197.14

172.98

198.16

177.08

176.87

164.65

167.14

173.15

217.94
	 	348.77

348.00

408.70

359.12

409.49

365.12

363.67

343.42

345.98

360.11

450.82
	 	9,915.21

9,915.29

11,139.05

10,499.53

11,579.82

10,652.98

10,979.18

9,334.36

10,422.05

13,515.82

14,158.52
	 	1,434.84

1,434.92

1,629.48

1,537.83

1,692.61

1,564.10

1,613.63

1,365.89

1,530.90

1,995.09

2,076.73
	 	438.23

444.47

496.42

471.87

516.20

477.61

491.76

417.70

466.81

608.51

632.27
	 	248.95264.93

279.20266.14

270.39277.50

275.78273.08

278.22298.64

268.98286.37

273.97292.05

232.02235.83

257.94263.00

339.22346.35

340.68352.44
	 	787.11

758.87

839.92

808.82

904.66

860.37

879.75

708.74

794.47

1,043.21

1,070.67
	 	726.07

720.06

818.38

780.50

861.50

808.82

831.07

688.94

773.52

1,017.18

1,045.82
	 	267.06

286.72

275.38

350.21

231.88

281.92

325.09

195.98

208.76

260.05

341.18
	 	110.40

113.69

101.75

112.15

107.72

92.55

100.89

99.12

101.52

113.76

169.15
	 	92.29

95.58

84.93

94.80

90.31

76.38

84.88

83.66

85.36

95.09

138.85
	TABLE 4

General + MH + Transportation Rates:

	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	
 
	 	 	 	 TANF
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N
	 	 	 	 	 	 	 	SSI-B
	 	SSI-AB






Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO
AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01

02

03

04

05

06

07

08

09

10

11

	 	1,118.75

1,118.76

1,281.58

1,115.15

1,243.79

1,097.25

1.115.00

1,047.92

1,185.95

1,104.68

1,428.21
	 	200.33

200.34

231.39

201.61

224.94

199.55

202.04

190.56

196.02

200.59

256.94
	 	106.30

107.55

122.43

107.13

118.94

106.72

107.68

101.24

104.26

107.22

136.08
	 	77.12

85.55

85.84

76.65

83.62

80.36

80.11

72.83

75.95

80.68

96.15
	 	145.59

148.04

162.13

142.36

159.46

146.91

147.83

134.64

139.24

143.93

179.96
	 	83.08

85.53

90.58

80.16

90.15

85.87

85.72

76.22

78.67

82.55

100.55
	 	268.47

267.45

308.77

269.73

301.97

271.77

273.49

256.16

262.26

269.89

341.69
	 	171.82

170.80

197.34

172.65

193.65

175.63

176.32

164.37

167.88

173.15

217.91
	 	348.55

347.78

407.02

356.86

398.78

360.83

361.29

341.09

345.85

358.93

449.71
	 	9,957.91

9,957.99

11,192.94

10,543.16

11,614.53

10,687.23

11,015.88

9,375.02

10,464.52

13,554.29

14,187.41
	 	1,462.40

1,462.48

1,664.26

1,565.99

1,714.99

1,586.20

1,637.42

1,392.12

1,558.31

2,019.92

2,095.37
	 	441.61

447.85

500.10

475.37

515.87

478.95

493.47

419.92

469.65

609.83

631.78
	 	247.63

277.88

267.71

274.51

271.82

265.53

270.76

229.03

255.72

335.04

334.99
	 	267.67

268.88

280.08

275.95

296.21

286.48

292.60

236.92

264.93

346.22

350.10
	 	803.95

775.71

861.25

825.67

913.23

871.79

893.60

723.92

812.36

1,058.87

1,080.40
	 	738.94

732.93

834.72

793.21

865.96

816.65

841.37

700.18

787.69

1,029.34

1,052.54
	 	273.23

292.89

283.33

355.09

233.30

285.34

329.04

200.51

214.85

265.22

341.70
	 	121.63

124.92

118.23

124.64

113.31

99.27

109.71

110.58

115.26

128.61

177.46
	 	99.45

102.74

95.44

102.76

93.85

80.64

90.50

90.96

94.12

104.55

144.14







AHCA Contract No. FA614, Exhibit III-C, Page 3 of 5



EXHIBIT III-C

January 1, 2008- 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 5	 	 	 	 	 	 
	General + Transportation Rates:

	 	

	 	

	 	

	TANF

	 	SSI-N
	 	SSI-B
	 	SSI-AB






Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO
AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	011,118.73200.31

021,118.73200.31

031,281.57231.38

041,115.14201.60

051,243.78224.93

061,097.23199.53

071,114.98202.02

081,047.91190.55

091,085.93196.00

101,104.66200.57

111,428.19256.92

	 	104.69

104.69

121.13

105.78

117.75

104.90

105.93

100.00

102.74

105.33

134.49
	 	65.63

65.63

76.81

67.25

75.09

67.33

67.63

64.18

65.32

67.54

85.05
	 	134.85

134.85

156.15

136.13

151.49

134.74

136.17

128.91

132.20

135.23

172.60
	 	72.34

72.34

84.60

73.93

82.18

73.70

74.06

70.49

71.63

73.85

93.19
	 	264.10

264.10

307.25

268.15

298.73

266.82

268.75

254.70

260.47

267.68

339.82
	 	167.45

167.45

195.82

171.07

190.41

170.68

171.58

162.91

166.09

170.94

216.04
	 	344.87

344.87

405.70

355.49

396.04

356.65

357.29

339.83

344.30

357.01

448.09
	 	9,957.83

9,957.83

11,192.87

10,543.05

11,614.48

10,687.16

11,015.82

9,374.95

10,464.45

13,554.20

14,187.33
	 	1,462.32

1,462.32

1,664.19

1,565.88

1,714.94

1,586.13

1,637.26

1,392.05

1,558.24

2,019.83

2,095.29
	 	434.29

434.29

493.94

465.78

510.93

472.54

487.45

414.02

463.42

601.62

624.92
	 	200.38

200.38

232.55

219.70

239.94

224.12

231.91

195.32

220.18

288.13

295.86
	 	224.42

224.42

259.91

244.51

267.03

248.58

257.04

217.57

244.53

319.30

327.65
	 	723.91

723.91

837.75

789.03

859.23

801.65

827.79

701.39

788.61

1,027.52

1,054.24
	 	708.47

708.47

823.63

775.91

845.41

789.96

816.22

689.54

776.47

1,014.54

1,040.19
	 	273.02

273.02

276.59

330.95

230.62

284.05

326.49

193.77

208.11

258.48

334.59
	 	110.17

110.17

109.40

108.15

100.71

95.45

99.37

97.58

105.83

120.69

169.54
	 	87.99

87.99

86.61

86.27

81.25

76.82

80.16

77.96

84.69

96.63

136.22
	TABLE 6

General + Dental Rates:

	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	TANF

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N
	 	 	 	 	 	 	 	 	 	 	 	SSI-B
	 	SSI-AB
	 	







Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO
AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01

02

03

04

05

06

07

08

09

10

11

	 	1,113.28

1,113.28

1,274.98

1,110.21

1,239.66

1,093.26

1,111.12

1,042.43

1,080.65

1,100.95

1,425.00
	 	198.96

198.96

229.74

200.38

223.92

198.55

201.06

189.19

194.69

199.65

256.13
	 	105.90

105.90

123.14

107.02

120.51

106.88

107.45

102.13

104.80

107.56

137.72
	 	69.37

69.37

82.43

70.94

81.73

72.32

71.64

69.82

70.76

72.98

92.41
	 	137.36

137.36

160.34

138.73

157.37

138.92

139.38

133.38

136.53

139.94

179.45
	 	74.81

74.81

88.57

76.45

87.40

77.49

77.02

74.62

75.62

78.07

99.17
	 	262.87

262.87

306.54

268.17

303.51

268.17

269.09

254.62

259.25

267.41

339.63
	 	166.72

166.72

195.62

171.40

194.92

172.13

172.13

163.19

165.35

170.94

216.07
	 	345.09

345.09

407.38

357.75

406.75

360.94

359.67

342.16

344.43

358.19

449.20
	 	9,915.13

9,915.13

11,138.98

10,499.42

11,579.77

10,652.91

10,979.12

9,334.29

10,421.98

13,515.73

14,158.44
	 	1,434.76

1,434.76

1,629.41

1,537.72

1,692.56

1,564.03

1,613.57

1,365.82

1,530.83

1,995.00

2,076.65
	 	430.91

430.91

490.26

462.28

511.26

471.20

485.74

411.80

460.58

600.30

625.41
	 	201.70

201.70

235.23

220.97

246.34

227.57

235.12

198.31

222.40

292.31

301.55
	 	221.68

221.68

257.33

241.64

269.46

248.47

256.49

216.48

242.60

319.43

329.99
	 	707.07

707.07

816.42

772.18

850.66

790.23

813.94

686.21

770.72

1,011.86

1,044.51
	 	695.60

695.60

807.29

763.20

841.05

782.13

806.02

678.30

762.30

1,002.38

1,033.47
	 	266.85

266.85

268.64

326.07

229.20

280.63

322.54

189.24

202.02

253.31

334.07
	 	98.94

98.94

92.92

95.66

95.12

88.73

90.55

86.12

92.09

105.84

161.23
	 	80.83

80.83

76.10

78.31

77.71

72.56

74.54

70.66

75.93

87.17

130.93






3





AHCA Contract No. FA614, Exhibit III-C, Page 4 of 5



EXHIBIT III-C

January 1, 2008 — 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 7	 	 	 	 	 	 
	General + Dental + Transportation Rates:

	 	

	 	

	 	

	TANF

	 	SSI-N
	 	SSI-B
	 	SSI-AB






Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO
AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	011,118.74200.32106.7569.88

021,118.74200.32106.7569.88

031,281.58231.39124.1683.05

041,115.15201.61107.7971.40

051,243.79224.95121.1582.12

061,097.24199.54107.5072.69

071,114.99202.03108.0572.01

081,047.92190.56102.9870.33

091,085.94196.01105.6271.26

101,104.67200.58108.1373.33

111,428.20256.93138.2192.71

	 	139.25

139.25

162.62

140.44

158.70

140.30

140.71

135.28

138.36

141.23

180.55
	 	76.05

76.05

90.06

77.57

88.33

78.39

77.89

75.86

76.82

78.91

99.89
	 	265.91

265.91

310.21

270.91

305.81

270.38

271.24

257.67

262.19

269.48

341.41
	 	169.06

169.06

198.45

173.52

196.70

173.84

173.79

165.54

167.62

172.54

217.45
	 	348.22

348.22

411.16

360.59

409.11

363.22

361.89

345.30

347.47

360.32

451.03
	 	9,957.83

9,957.83

11,192.88

10,543.05

11,614.49

10,687.16

11,015.82

9,374.95

10,464.45

13,554.21

14,187.34
	 	1,462.33

1,462.33

1,664.21

1,565.89

1,714.96

1,586.14

1,637.27

1,392.06

1,558.25

2,019.85

2,095.31
	 	436.46

436.46

497.26

467.95

515.77

475.66

490.51

417.09

466.11

605.30

629.16
	 	204.14

204.14

238.30

223.46

248.32

229.53

237.21

200.64

224.83

294.51

303.20
	 	227.70

227.70

264.93

247.80

274.36

253.31

261.67

222.22

248.60

324.87

334.07
	 	726.73

726.73

841.25

792.28

866.65

806.00

830.85

704.93

790.27

1,029.59

1,057.82
	 	711.83

711.83

827.80

779.79

854.25

795.15

819.97

693.76

778.45

1,017.01

1,044.45
	 	273.51

273.51

277.12

332.92

234.98

285.86

328.09

195.22

208.82

260.50

338.91
	 	112.44

112.44

112.43

111.18

108.92

100.15

102.48

100.68

107.64

123.21

173.53
	 	89.44

89.44

88.55

88.21

86.51

79.84

82.16

79.95

85.85

98.25

138.78
	TABLE 8

General + Mental Health + Dental + Transportation Rates:

	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	 	



	TANF

	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N
	 	 	 	 	 	 	 	 	 	 	 	SSI-B
	 	SSI-AB
	 	







Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO
AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01

02

03

04

05

06

07

08

09

10

11

	 	1,118.76

1,118.77

1,281.59

1,115.16

1,243.80

1,097.26

1,115.01

1,047.93

1,085.96

1,104.69

1,428.22
	 	200.34

200.35

231.40

201.62

224.96

199.56

202.05

190.57

196.03

200.60

256.95
	 	108.36

109.61

125.46

109.14

122.34

109.32

109.80

104.22

107.14

110.02

139.80
	 	81.37

89.80

92.08

80.80

90.65

85.72

84.49

78.98

81.89

86.47

103.81
	 	149.99

152.44

168.60

146.67

166.76

152.47

152.37

141.01

145.40

149.93

187.91
	 	86.79

89.24

96.04

83.80

96.30

90.56

89.55

81.59

83.86

87.61

107.25
	 	270.28

269.26

311.73

272.49

309.05

275.33

275.98

259.13

263.98

271.69

343.28
	 	173.43

172.41

199.97

175.10

199.94

178.79

178.53

167.00

169.41

174.75

219.32
	 	351.90

351.13

412.48

361.96

411.85

367.40

365.89

346.56

349.02

362.24

452.65
	 	9,957.91

9,957.99

11,192.95

10,543.16

11,614.54

10,687.23

11,015.88

9,375.02

10,464.52

13,554.30

14,187.42
	 	1,462.41

1,462.49

1,664.28

1,566.00

1,715.01

1,586.21

1,637.33

1,392.13

1,558.32

2,019.94

2,095.39
	 	443.78

450.02

503.42

477.54

520.71

482.07

496.53

422.99

472.34

613.51

636.02
	 	251.39

281.64

273.46

278.27

280.20

270.94

276.06

234.35

260.37

341.42

342.33
	 	270.95

272.16

285.10

279.24

303.54

291.21

297.33

241.57

269.00

351.79

356.52
	 	806.77

778.53

864.75

828.92

920.65

876.14

896.66

727.46

814.02

1,060.94

1,083.98
	 	742.30

736.29

838.89

797.09

874.80

821.84

845.02

704.40

789.67

1,031.81

1,056.80
	 	273.72

293.38

283.86

357.06

237.66

287.15

330.64

201.96

215.56

267.24

346.02
	 	123.90

127.19

121.26

127.67

121.52

103.97

112.82

113.68

117.07

131.13

181.45
	 	100.90

104.19

97.38

104.70

99.11

83.66

92.50

92.95

95.28

106.17

146.70






EXHIBIT III-C

January 1, 2008- August 31, 2008

Medicaid Non-Reform HMO Capitation Rates

By Area , Age and Eligibility Category




	 	 	 
	Area

Area 1

Area 2

Area 3

Area 4

Area 5

Area 6

Area 7

Area 8

Area 9

Area 10

Area 11

	 	ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

Corresponding Counties

Escambia, Okaloosa, Santa Rosa, Walton

Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, Wakulla

Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamiliton, Hemando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union

Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia

Pasco, Pinellas

Hardee, Highlands, Hillsborough, Manatee, Polk

Brevard, Orange, Osceola, Seminole

Charlotte, Collier, De Soto, Glades, Hendry, Lee, Sarasota

Indian River, Okeechobee, St. Lucie, Martin, Palm Beach

Broward

Dade, Monroe






Created on August 19, 2006 modified on September 11, 2006 – increased dental ratesAHCA
Contract No. FA614, Exhibit III-C, Page 5 of 5




4