Amerigroup Florida, Inc. 
d/b/a Amerigroup Community Care
    
    Medicaid HMO Contract
 
 THIS CONTRACT, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, AMERIGROUP FLORIDA, INC. D/B/A AMERIGROUP COMMUNITY
CARE,
 1.
    
    Standard Contract, Section III, Item C., Contract Managers, sub-item 1, is hereby amended
to now read as follows:
  
 2.
    
    Effective March 1, 2009, Attachment I, Scope of Services, is hereby amended to include
Exhibit I-E, Fifth Revised Maximum Enrollment Levels, attached hereto and made a part of
the Contract. All references in the Contract to Exhibit I-D, Fourth Revised Maximum
Enrollment Levels, shall hereinafter also refer to Exhibit I-E, Fifth Revised Maximum
Enrollment Levels, as appropriate.3.
    
    Effective March 1, 2009, Attachment I, Scope of Services, is hereby amended to include
Exhibit III-F, March 1, 2009  August 31, 2009 Medicaid Non-Reform HMO Capitation Rates,
attached hereto and made a part of the Contract. All references in the Contract to Exhibit
III-E, February 1, 2009  August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, shall
hereinafter also refer to Exhibit III-F, March 1, 2009  August 31, 2009 Medicaid
Non-Reform HMO Capitation Rates, as appropriate.
     REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
 AHCA Contract No. FA614, Amendment No. 13, Page 1 of 2




---



##### 



Amerigroup Florida, Inc. 
d/b/a Amerigroup Community Care
    
    Medicaid HMO Contract
  AMERIGROUP FLORIDA, INC. 
D/B/A/ AMERIGROUP COMMUNITY
CARE
    
    STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATIONSigned By:
    
    /s/ William L. McHugh
    
    Signed By:
    
    /s/ Holly BensonNAME:
    
    William L. McHugh
    
    
    
    NAME:
    
    Holly BensonTITLE:
    
    CEO
    
    
    
    TITLE:
    
    SecretaryDATE:
    
    3/20/09
    
    
    
    DATE:
    
    3/26/09
  Specify
    
    Letter/Type
    
    Number
    
    DescriptionExhibit
    
    I-E
    
    Fifth Revised Maximum Enrollment Levels (1 Page)Exhibit
    
    III- F
    
    March 1, 2009  August 31, 2009 Medicaid Non-Reform
HMO Capitation RatesS (5 Pages)
 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
 AHCA Contract No. FA614, Amendment No. 13, Page 2 of 2




---



##### 



Amerigroup Florida, Inc. 
d/b/a Amerigroup Community Care
    
    Medicaid HMO Contract
 EXHIBIT I-E
 FIFTH REVISED MAXIMUM ENROLLMENT LEVELS
 TABLE 1
FOURTH REVISED ENROLLMENT LEVELS
 County
    
    Maximum Enrollment LevelBrevard
    
    
    8,000Broward
    
    
    14,000Miami-Dade
    
    
    25,000Hernando
    
    
    8,000Hillsborough
    
    
    40,000Lake
    
    
    8,000Lee
    
    
    18,000Manatee
    
    
    8,000Orange
    
    
    30,000Osceola
    
    
    8,500Pasco
    
    
    15,000Pinellas
    
    
    25,000Polk
    
    
    30,000Sarasota
    
    
    8,000Seminole
    
    
    8,000Volusia
    
    
    8,000
 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
 AHCA Contract No. FA614, Exhibit I-E, Page 1 of 1




---



##### 



Amerigroup Florida, Inc. 
d/b/a Amerigroup Community Care
    
    Medicaid HMO Contract
 EXHIBIT III-F
March 1, 2009  August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009
 TABLE 1
 General Rates:
 TANFAGE (14-20)
    
    
    
    
    
    AGE (21-54)
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-N
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-ABArea
    
    BTHM0+2M0
    
    3M0.11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    Female
    
    Male
    
    Female
    
    Male
    
    AGE (55+)
    
    BTHMO+2M0
    
    3M0-11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    AGE (14-20)
    
    AGE (21-54)
    
    AGE (55+)
    
    SSI-B
    
    AGE (65-)
    
    AGE (65+)01
    
    
    1,094.22
    
    
    
    184.16
    
    
    
    99.63
    
    
    
    60.40
    
    
    
    127.26
    
    
    
    68.32
    
    
    
    250.84
    
    
    
    150.73
    
    
    
    313.03
    
    
    
    10,249.54
    
    
    
    1,491.48
    
    
    
    438.21
    
    
    
    195.46
    
    
    
    209.48
    
    
    
    684.74
    
    
    
    688.27
    
    
    
    300.62
    
    
    
    93.17
    
    
    
    84.3002
    
    
    1,094.22
    
    
    
    184.16
    
    
    
    99.63
    
    
    
    60.40
    
    
    
    127.26
    
    
    
    68.32
    
    
    
    250.84
    
    
    
    150.73
    
    
    
    313.03
    
    
    
    10,249.54
    
    
    
    1,491.48
    
    
    
    438.21
    
    
    
    195.46
    
    
    
    209.48
    
    
    
    684.74
    
    
    
    688.27
    
    
    
    300.62
    
    
    
    93.17
    
    
    
    84.3003
    
    
    1,196.62
    
    
    
    202.96
    
    
    
    110.34
    
    
    
    67.92
    
    
    
    140.84
    
    
    
    76.51
    
    
    
    278.65
    
    
    
    168.47
    
    
    
    353.53
    
    
    
    11,246.01
    
    
    
    1,651.16
    
    
    
    486.56
    
    
    
    222.16
    
    
    
    237.31
    
    
    
    773.96
    
    
    
    781.87
    
    
    
    334.70
    
    
    
    88.46
    
    
    
    80.5704
    
    
    1,049.14
    
    
    
    178.79
    
    
    
    97.34
    
    
    
    60.45
    
    
    
    124.13
    
    
    
    68.04
    
    
    
    246.51
    
    
    
    149.64
    
    
    
    315.69
    
    
    
    10,783.85
    
    
    
    1,587.50
    
    
    
    468.19
    
    
    
    215.03
    
    
    
    229.34
    
    
    
    748.28
    
    
    
    757.29
    
    
    
    292.70
    
    
    
    88.80
    
    
    
    80.9805
    
    
    1,194.06
    
    
    
    202.97
    
    
    
    110.37
    
    
    
    68.18
    
    
    
    140.78
    
    
    
    76.87
    
    
    
    279.19
    
    
    
    169.16
    
    
    
    355.65
    
    
    
    12,038.26
    
    
    
    1,765.98
    
    
    
    519.70
    
    
    
    236.81
    
    
    
    252.51
    
    
    
    825.86
    
    
    
    834.51
    
    
    
    221.32
    
    
    
    79.80
    
    
    
    74.0006
    
    
    1,038.39
    
    
    
    178.07
    
    
    
    97.17
    
    
    
    60.92
    
    
    
    124.01
    
    
    
    68.48
    
    
    
    247.03
    
    
    
    150.57
    
    
    
    319.86
    
    
    
    10,970.19
    
    
    
    1,617.13
    
    
    
    476.72
    
    
    
    220.10
    
    
    
    233.82
    
    
    
    764.56
    
    
    
    774.50
    
    
    
    270.21
    
    
    
    77.95
    
    
    
    71.3807
    
    
    1,074.14
    
    
    
    183.63
    
    
    
    100.12
    
    
    
    62.40
    
    
    
    127.54
    
    
    
    70.12
    
    
    
    253.83
    
    
    
    154.32
    
    
    
    326.38
    
    
    
    11,607.26
    
    
    
    1,714.80
    
    
    
    505.56
    
    
    
    234.47
    
    
    
    249.97
    
    
    
    814.51
    
    
    
    826.24
    
    
    
    367.55
    
    
    
    83.10
    
    
    
    76.2808
    
    
    1,015.73
    
    
    
    174.04
    
    
    
    95.01
    
    
    
    59.33
    
    
    
    121.03
    
    
    
    66.85
    
    
    
    241.01
    
    
    
    146.72
    
    
    
    311.46
    
    
    
    10,344.94
    
    
    
    1,523.63
    
    
    
    449.17
    
    
    
    206.42
    
    
    
    220.49
    
    
    
    718.78
    
    
    
    727.41
    
    
    
    251.83
    
    
    
    77.41
    
    
    
    70.9809
    
    
    1,049.42
    
    
    
    178.45
    
    
    
    97.12
    
    
    
    60.00
    
    
    
    123.89
    
    
    
    67.48
    
    
    
    245.50
    
    
    
    148.81
    
    
    
    312.90
    
    
    
    10,887.75
    
    
    
    1,607.33
    
    
    
    473.84
    
    
    
    219.83
    
    
    
    233.26
    
    
    
    762.25
    
    
    
    772.33
    
    
    
    215.52
    
    
    
    82.97
    
    
    
    75.8710
    
    
    1,064.83
    
    
    
    182.89
    
    
    
    99.98
    
    
    
    62.78
    
    
    
    127.46
    
    
    
    70.63
    
    
    
    254.09
    
    
    
    155.07
    
    
    
    330.14
    
    
    
    14,097.57
    
    
    
    2,095.67
    
    
    
    618.54
    
    
    
    292.06
    
    
    
    308.77
    
    
    
    1,009.40
    
    
    
    1,026.88
    
    
    
    316.67
    
    
    
    92.40
    
    
    
    84.7311
    
    
    1,348.59
    
    
    
    228.59
    
    
    
    124.07
    
    
    
    76.21
    
    
    
    158.52
    
    
    
    85.96
    
    
    
    313.61
    
    
    
    189.56
    
    
    
    397.28
    
    
    
    14,238.94
    
    
    
    2,095.21
    
    
    
    617.24
    
    
    
    284.21
    
    
    
    302.64
    
    
    
    987.26
    
    
    
    998.51
    
    
    
    364.12
    
    
    
    137.86
    
    
    
    124.456B*
    
    
    1,038.25
    
    
    
    178.05
    
    
    
    97.16
    
    
    
    60.91
    
    
    
    123.99
    
    
    
    68.47
    
    
    
    247.00
    
    
    
    150.55
    
    
    
    319.81
    
    
    
    10,969.70
    
    
    
    1,617.05
    
    
    
    476.70
    
    
    
    220.09
    
    
    
    233.81
    
    
    
    764.51
    
    
    
    774.47
    
    
    
    270.21
    
    
    
    77.95
    
    
    
    71.38
 TABLE 2
 General + Mental Health Rates:
 TANFAGE (14-20)
    
    
    
    
    
    AGE (21-54)
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-N
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-ABArea
    
    BTHM0+2M0
    
    3M0.11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    Female
    
    Male
    
    Female
    
    Male
    
    AGE (55+)
    
    BTHMO+2M0
    
    3M0-11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    AGE (14-20)
    
    AGE (21-54)
    
    AGE (55+)
    
    SSI-B
    
    AGE (65-)
    
    AGE (65+)01
    
    
    1,094.24
    
    
    
    184.16
    
    
    
    101.24
    
    
    
    71.89
    
    
    
    138.00
    
    
    
    79.06
    
    
    
    255.20
    
    
    
    155.09
    
    
    
    316.71
    
    
    
    10,249.62
    
    
    
    1,491.56
    
    
    
    445.52
    
    
    
    242.68
    
    
    
    252.71
    
    
    
    764.74
    
    
    
    718.72
    
    
    
    300.83
    
    
    
    104.62
    
    
    
    95.7502
    
    
    1,094.25
    
    
    
    184.16
    
    
    
    102.49
    
    
    
    80.31
    
    
    
    140.45
    
    
    
    81.51
    
    
    
    254.19
    
    
    
    154.08
    
    
    
    315.93
    
    
    
    10,249.69
    
    
    
    1,491.63
    
    
    
    451.77
    
    
    
    272.92
    
    
    
    253.92
    
    
    
    736.51
    
    
    
    712.72
    
    
    
    320.48
    
    
    
    107.92
    
    
    
    99.0503
    
    
    1,196.63
    
    
    
    202.96
    
    
    
    111.64
    
    
    
    76.94
    
    
    
    146.82
    
    
    
    82.49
    
    
    
    280.17
    
    
    
    169.99
    
    
    
    354.85
    
    
    
    11,246.08
    
    
    
    1,651.23
    
    
    
    492.71
    
    
    
    257.30
    
    
    
    257.47
    
    
    
    797.45
    
    
    
    791.96
    
    
    
    341.43
    
    
    
    97.29
    
    
    
    89.4004
    
    
    1,049.15
    
    
    
    178.79
    
    
    
    98.69
    
    
    
    69.84
    
    
    
    130.36
    
    
    
    74.27
    
    
    
    248.09
    
    
    
    151.22
    
    
    
    317.06
    
    
    
    10,783.96
    
    
    
    1,587.61
    
    
    
    477.78
    
    
    
    269.81
    
    
    
    260.77
    
    
    
    784.90
    
    
    
    774.58
    
    
    
    316.83
    
    
    
    105.28
    
    
    
    97.4505
    
    
    1,194.07
    
    
    
    202.97
    
    
    
    111.56
    
    
    
    76.71
    
    
    
    148.75
    
    
    
    84.84
    
    
    
    282.43
    
    
    
    172.40
    
    
    
    358.38
    
    
    
    12,038.31
    
    
    
    1,766.03
    
    
    
    524.64
    
    
    
    268.67
    
    
    
    281.68
    
    
    
    879.83
    
    
    
    855.05
    
    
    
    224.00
    
    
    
    92.40
    
    
    
    86.6006
    
    
    1,038.41
    
    
    
    178.07
    
    
    
    98.99
    
    
    
    73.94
    
    
    
    136.17
    
    
    
    80.64
    
    
    
    251.97
    
    
    
    155.51
    
    
    
    324.03
    
    
    
    10,970.26
    
    
    
    1,617.20
    
    
    
    483.13
    
    
    
    261.48
    
    
    
    271.70
    
    
    
    834.66
    
    
    
    801.18
    
    
    
    271.50
    
    
    
    81.77
    
    
    
    75.2007
    
    
    1,074.16
    
    
    
    183.63
    
    
    
    101.87
    
    
    
    74.87
    
    
    
    139.19
    
    
    
    81.77
    
    
    
    258.57
    
    
    
    159.06
    
    
    
    330.38
    
    
    
    11,607.32
    
    
    
    1,714.86
    
    
    
    511.58
    
    
    
    273.30
    
    
    
    285.42
    
    
    
    880.29
    
    
    
    851.28
    
    
    
    370.10
    
    
    
    93.44
    
    
    
    86.6208
    
    
    1,015.74
    
    
    
    174.04
    
    
    
    96.25
    
    
    
    67.97
    
    
    
    126.75
    
    
    
    72.57
    
    
    
    242.47
    
    
    
    148.18
    
    
    
    312.72
    
    
    
    10,345.01
    
    
    
    1,523.70
    
    
    
    455.07
    
    
    
    240.11
    
    
    
    239.83
    
    
    
    741.30
    
    
    
    738.04
    
    
    
    258.56
    
    
    
    90.40
    
    
    
    83.9709
    
    
    1,049.44
    
    
    
    178.47
    
    
    
    98.64
    
    
    
    70.62
    
    
    
    130.92
    
    
    
    74.51
    
    
    
    247.29
    
    
    
    150.60
    
    
    
    314.45
    
    
    
    10,887.82
    
    
    
    1,607.40
    
    
    
    480.06
    
    
    
    255.35
    
    
    
    253.65
    
    
    
    785.99
    
    
    
    783.54
    
    
    
    222.25
    
    
    
    92.39
    
    
    
    85.2910
    
    
    1,064.85
    
    
    
    182.91
    
    
    
    101.87
    
    
    
    75.91
    
    
    
    136.16
    
    
    
    79.33
    
    
    
    256.30
    
    
    
    157.28
    
    
    
    332.60
    
    
    
    14,097.66
    
    
    
    2,095.76
    
    
    
    626.75
    
    
    
    338.95
    
    
    
    335.68
    
    
    
    1,040.74
    
    
    
    1,041.68
    
    
    
    323.40
    
    
    
    100.32
    
    
    
    92.6511
    
    
    1,348.61
    
    
    
    228.61
    
    
    
    125.66
    
    
    
    87.31
    
    
    
    165.88
    
    
    
    93.32
    
    
    
    315.48
    
    
    
    191.43
    
    
    
    398.90
    
    
    
    14,239.02
    
    
    
    2,095.29
    
    
    
    624.09
    
    
    
    323.33
    
    
    
    325.08
    
    
    
    1,013.40
    
    
    
    1,010.85
    
    
    
    371.22
    
    
    
    145.78
    
    
    
    132.376B*
    
    
    1,038.27
    
    
    
    178.07
    
    
    
    98.88
    
    
    
    73.21
    
    
    
    135.48
    
    
    
    79.96
    
    
    
    251.67
    
    
    
    155.22
    
    
    
    323.75
    
    
    
    10,969.77
    
    
    
    1,617.72
    
    
    
    483.09
    
    
    
    261.35
    
    
    
    271.58
    
    
    
    834.41
    
    
    
    801.07
    
    
    
    271.50
    
    
    
    81.77
    
    
    
    75.20
 AHCA Contract No. FA614, Exhibit III-F, Page 1 of 1




---



##### 



EXHIBIT III-F
March 1, 2009  August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009
 TABLE 3
 General + MH + Dental Rates:
 TANF
    
    
    
    
    
    
    
    
    
    
    
    
    
    AGE (14-20)
    
    
    
    
    
    AGE (21.54)
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-N
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-ABArea
    
    BTHM0+2M0
    
    3M0.11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    Female
    
    Male
    
    Female
    
    Male
    
    AGE (55+)
    
    BTHMO+2M0
    
    3M0-11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    AGE (14-20)
    
    AGE (21-54)
    
    AGE (55+)
    
    SSI-B
    
    AGE (65-)
    
    AGE (65+)01
    
    
    1,094.24
    
    
    
    184.19
    
    
    
    102.89
    
    
    
    74.95
    
    
    
    141.13
    
    
    
    81.70
    
    
    
    256.40
    
    
    
    156.33
    
    
    
    319.45
    
    
    
    10,249.62
    
    
    
    1,491.56
    
    
    
    447.11
    
    
    
    245.04
    
    
    
    254.73
    
    
    
    766.05
    
    
    
    720.55
    
    
    
    301.27
    
    
    
    105.72
    
    
    
    96.6002
    
    
    1,094.25
    
    
    
    184.20
    
    
    
    104.14
    
    
    
    83.37
    
    
    
    143.58
    
    
    
    84.15
    
    
    
    256.39
    
    
    
    155.32
    
    
    
    318.67
    
    
    
    10,249.69
    
    
    
    1,491.63
    
    
    
    453.36
    
    
    
    275.28
    
    
    
    255.94
    
    
    
    737.82
    
    
    
    714.55
    
    
    
    320.92
    
    
    
    109.02
    
    
    
    99.9003
    
    
    1,196.64
    
    
    
    202.99
    
    
    
    114.64
    
    
    
    82.50
    
    
    
    152.49
    
    
    
    87.29
    
    
    
    281.88
    
    
    
    171.74
    
    
    
    358.75
    
    
    
    11,246.08
    
    
    
    1,651.24
    
    
    
    495.79
    
    
    
    261.86
    
    
    
    261.39
    
    
    
    799.30
    
    
    
    795.56
    
    
    
    342.44
    
    
    
    98.91
    
    
    
    90.6404
    
    
    1,049.16
    
    
    
    178.81
    
    
    
    100.50
    
    
    
    73.20
    
    
    
    133.80
    
    
    
    77.17
    
    
    
    249.73
    
    
    
    152.91
    
    
    
    320.81
    
    
    
    10,783.96
    
    
    
    1,587.61
    
    
    
    479.53
    
    
    
    272.40
    
    
    
    263.00
    
    
    
    786.75
    
    
    
    777.17
    
    
    
    318.97
    
    
    
    106.84
    
    
    
    98.6505
    
    
    1,194.08
    
    
    
    203.00
    
    
    
    114.91
    
    
    
    82.93
    
    
    
    155.11
    
    
    
    90.22
    
    
    
    285.78
    
    
    
    175.85
    
    
    
    366.04
    
    
    
    12,038.32
    
    
    
    1,766.04
    
    
    
    528.79
    
    
    
    274.83
    
    
    
    286.97
    
    
    
    883.47
    
    
    
    860.16
    
    
    
    227.60
    
    
    
    96.12
    
    
    
    89.4406
    
    
    1,038.42
    
    
    
    178.10
    
    
    
    101.61
    
    
    
    78.81
    
    
    
    141.14
    
    
    
    84.85
    
    
    
    253.82
    
    
    
    157.42
    
    
    
    328.26
    
    
    
    10,970.26
    
    
    
    1,617.21
    
    
    
    486.12
    
    
    
    265.90
    
    
    
    275.50
    
    
    
    837.12
    
    
    
    804.63
    
    
    
    273.23
    
    
    
    83.98
    
    
    
    76.8807
    
    
    1,074.17
    
    
    
    183.66
    
    
    
    104.23
    
    
    
    79.24
    
    
    
    143.65
    
    
    
    85.54
    
    
    
    259.88
    
    
    
    160.40
    
    
    
    333.37
    
    
    
    11,607.32
    
    
    
    1,714.87
    
    
    
    514.53
    
    
    
    277.66
    
    
    
    289.17
    
    
    
    881.81
    
    
    
    853.42
    
    
    
    370.57
    
    
    
    94.93
    
    
    
    87.7608
    
    
    1,015.75
    
    
    
    174.07
    
    
    
    99.83
    
    
    
    74.59
    
    
    
    133.52
    
    
    
    78.30
    
    
    
    244.46
    
    
    
    150.21
    
    
    
    317.24
    
    
    
    10,345.01
    
    
    
    1,523.71
    
    
    
    458.43
    
    
    
    245.10
    
    
    
    244.12
    
    
    
    743.54
    
    
    
    741.18
    
    
    
    260.07
    
    
    
    92.04
    
    
    
    85.2209
    
    
    1,049.45
    
    
    
    178.49
    
    
    
    101.52
    
    
    
    75.97
    
    
    
    136.38
    
    
    
    79.13
    
    
    
    248.23
    
    
    
    151.66
    
    
    
    316.60
    
    
    
    10,887.82
    
    
    
    1,607.41
    
    
    
    482.61
    
    
    
    259.13
    
    
    
    256.90
    
    
    
    787.15
    
    
    
    785.16
    
    
    
    224.05
    
    
    
    93.44
    
    
    
    86.0910
    
    
    1,064.86
    
    
    
    182.92
    
    
    
    104.26
    
    
    
    80.34
    
    
    
    140.69
    
    
    
    83.16
    
    
    
    257.02
    
    
    
    158.02
    
    
    
    333.69
    
    
    
    14,097.66
    
    
    
    2,095.77
    
    
    
    629.49
    
    
    
    343.02
    
    
    
    339.18
    
    
    
    1,041.67
    
    
    
    1,042.99
    
    
    
    324.21
    
    
    
    101.60
    
    
    
    93.6111
    
    
    1,348.62
    
    
    
    228.62
    
    
    
    129.33
    
    
    
    94.86
    
    
    
    173.71
    
    
    
    99.92
    
    
    
    316.33
    
    
    
    192.29
    
    
    
    400.83
    
    
    
    14,239.03
    
    
    
    2,095.31
    
    
    
    628.29
    
    
    
    330.59
    
    
    
    331.44
    
    
    
    1,015.15
    
    
    
    1,013.31
    
    
    
    374.50
    
    
    
    147.90
    
    
    
    133.996B*
    
    
    1,038.28
    
    
    
    178.08
    
    
    
    101.50
    
    
    
    78.08
    
    
    
    140.45
    
    
    
    84.17
    
    
    
    251.67
    
    
    
    155.22
    
    
    
    323.75
    
    
    
    10,969.77
    
    
    
    1,617.13
    
    
    
    486.08
    
    
    
    265.77
    
    
    
    275.38
    
    
    
    834.41
    
    
    
    801.07
    
    
    
    273.23
    
    
    
    83.98
    
    
    
    76.88
 TABLE 4
 General + Mental Health + Transportation Rates:
 TANFAGE (14-20)
    
    
    
    
    
    AGE (21-54)
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-N
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-ABArea
    
    BTHM0+2M0
    
    3M0.11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    Female
    
    Male
    
    Female
    
    Male
    
    AGE (55+)
    
    BTHMO+2M0
    
    3M0-11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    AGE (14-20)
    
    AGE (21-54)
    
    AGE (55+)
    
    SSI-B
    
    AGE (65-)
    
    AGE (65+)01
    
    
    1,099.50
    
    
    
    185.53
    
    
    
    102.06
    
    
    
    72.38
    
    
    
    140.00
    
    
    
    80.38
    
    
    
    258.44
    
    
    
    157.56
    
    
    
    320.16
    
    
    
    10,288.04
    
    
    
    1,516.79
    
    
    
    450.72
    
    
    
    245.07
    
    
    
    258.73
    
    
    
    784.45
    
    
    
    735.36
    
    
    
    308.17
    
    
    
    118.10
    
    
    
    104.4402
    
    
    1,099.51
    
    
    
    185.54
    
    
    
    103.31
    
    
    
    80.80
    
    
    
    142.45
    
    
    
    82.83
    
    
    
    257.43
    
    
    
    156.55
    
    
    
    319.38
    
    
    
    10,288.11
    
    
    
    1,516.86
    
    
    
    456.97
    
    
    
    275.31
    
    
    
    259.94
    
    
    
    756.22
    
    
    
    729.36
    
    
    
    327.82
    
    
    
    121.40
    
    
    
    107.7403
    
    
    1,202.95
    
    
    
    204.60
    
    
    
    112.62
    
    
    
    77.53
    
    
    
    149.22
    
    
    
    84.07
    
    
    
    284.07
    
    
    
    172.96
    
    
    
    359.00
    
    
    
    11,294.54
    
    
    
    1,683.05
    
    
    
    499.28
    
    
    
    260.32
    
    
    
    265.06
    
    
    
    822.32
    
    
    
    813.95
    
    
    
    349.99
    
    
    
    116.72
    
    
    
    101.9204
    
    
    1,053.64
    
    
    
    179.96
    
    
    
    99.39
    
    
    
    70.26
    
    
    
    132.07
    
    
    
    75.40
    
    
    
    250.86
    
    
    
    153.32
    
    
    
    320.01
    
    
    
    10,821.63
    
    
    
    1,612.34
    
    
    
    482.87
    
    
    
    272.15
    
    
    
    266.67
    
    
    
    804.22
    
    
    
    790.89
    
    
    
    323.89
    
    
    
    120.86
    
    
    
    107.5005
    
    
    1,197.87
    
    
    
    203.96
    
    
    
    112.15
    
    
    
    77.06
    
    
    
    160.19
    
    
    
    85.79
    
    
    
    284.77
    
    
    
    174.18
    
    
    
    360.87
    
    
    
    12,069.58
    
    
    
    1,786.55
    
    
    
    528.88
    
    
    
    270.62
    
    
    
    286.57
    
    
    
    895.87
    
    
    
    868.59
    
    
    
    230.44
    
    
    
    106.24
    
    
    
    95.5106
    
    
    1,042.14
    
    
    
    179.05
    
    
    
    99.57
    
    
    
    74.29
    
    
    
    137.59
    
    
    
    81.57
    
    
    
    254.28
    
    
    
    157.27
    
    
    
    326.48
    
    
    
    11,001.22
    
    
    
    1,637.53
    
    
    
    487.33
    
    
    
    263.40
    
    
    
    276.55
    
    
    
    850.54
    
    
    
    814.59
    
    
    
    277.11
    
    
    
    93.13
    
    
    
    82.5207
    
    
    1,078.12
    
    
    
    184.66
    
    
    
    102.49
    
    
    
    75.24
    
    
    
    140.69
    
    
    
    82.77
    
    
    
    261.02
    
    
    
    160.93
    
    
    
    332.97
    
    
    
    11,641.47
    
    
    
    1,737.28
    
    
    
    516.20
    
    
    
    275.41
    
    
    
    290.77
    
    
    
    897.81
    
    
    
    866.07
    
    
    
    375.39
    
    
    
    105.36
    
    
    
    94.3008
    
    
    1,020.94
    
    
    
    175.39
    
    
    
    97.07
    
    
    
    68.46
    
    
    
    128.74
    
    
    
    73.88
    
    
    
    245.67
    
    
    
    150.62
    
    
    
    316.13
    
    
    
    10,382.57
    
    
    
    1,548.36
    
    
    
    460.15
    
    
    
    242.45
    
    
    
    245.71
    
    
    
    760.56
    
    
    
    754.32
    
    
    
    264.39
    
    
    
    104.94
    
    
    
    93.3309
    
    
    1,054.46
    
    
    
    179.77
    
    
    
    99.43
    
    
    
    71.09
    
    
    
    132.83
    
    
    
    75.77
    
    
    
    250.39
    
    
    
    152.96
    
    
    
    317.74
    
    
    
    10,926.48
    
    
    
    1,632.80
    
    
    
    485.30
    
    
    
    257.76
    
    
    
    259.70
    
    
    
    805.82
    
    
    
    800.29
    
    
    
    228.70
    
    
    
    107.92
    
    
    
    95.2910
    
    
    1,067.79
    
    
    
    183.68
    
    
    
    102.33
    
    
    
    76.19
    
    
    
    137.28
    
    
    
    80.07
    
    
    
    258.11
    
    
    
    158.66
    
    
    
    333.99
    
    
    
    14,123.46
    
    
    
    2,112.70
    
    
    
    630.24
    
    
    
    340.55
    
    
    
    339.72
    
    
    
    1,053.97
    
    
    
    1,052.85
    
    
    
    328.61
    
    
    
    112.45
    
    
    
    100.4611
    
    
    1,351.65
    
    
    
    229.39
    
    
    
    126.13
    
    
    
    87.60
    
    
    
    167.04
    
    
    
    94.09
    
    
    
    317.36
    
    
    
    192.86
    
    
    
    400.90
    
    
    
    14,265.93
    
    
    
    2,112.95
    
    
    
    627.73
    
    
    
    325.00
    
    
    
    329.30
    
    
    
    1,027.20
    
    
    
    1,022.51
    
    
    
    376.25
    
    
    
    158.01
    
    
    
    140.246B*
    
    
    1,042.00
    
    
    
    179.03
    
    
    
    99.46
    
    
    
    73.56
    
    
    
    136.90
    
    
    
    80.89
    
    
    
    253.98
    
    
    
    156.98
    
    
    
    326.20
    
    
    
    11,000.73
    
    
    
    1,637.45
    
    
    
    487.29
    
    
    
    263.27
    
    
    
    276.43
    
    
    
    850.29
    
    
    
    814.48
    
    
    
    277.11
    
    
    
    93.13
    
    
    
    82.52
 AHCA Contract No. FA614, Exhibit III-F, Page 2 of 5




---



##### 



EXHIBIT III-F
March 1, 2009  August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009
 TABLE 5
 General + Transportation Rates:
 TANF
    
    
    
    
    
    
    
    
    
    
    
    
    
    AGE (14-20)
    
    
    
    
    
    AGE (21.54)
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-N
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-ABArea
    
    BTHM0+2M0
    
    3M0.11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    Female
    
    Male
    
    Female
    
    Male
    
    AGE (55+)
    
    BTHMO+2M0
    
    3M0-11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    AGE (14-20)
    
    AGE (21-54)
    
    AGE (55+)
    
    SSI-B
    
    AGE (65-)
    
    AGE (65+)01
    
    
    1,099.48
    
    
    
    185.51
    
    
    
    100.45
    
    
    
    60.89
    
    
    
    129.26
    
    
    
    69.64
    
    
    
    254.08
    
    
    
    153.20
    
    
    
    316.48
    
    
    
    10,287.96
    
    
    
    1,516.71
    
    
    
    443.41
    
    
    
    197.85
    
    
    
    215.50
    
    
    
    704.45
    
    
    
    704.91
    
    
    
    307.96
    
    
    
    106.65
    
    
    
    92.9902
    
    
    1,099.48
    
    
    
    185.51
    
    
    
    100.45
    
    
    
    60.89
    
    
    
    129.26
    
    
    
    69.64
    
    
    
    254.08
    
    
    
    153.20
    
    
    
    316.48
    
    
    
    10,287.96
    
    
    
    1,516.71
    
    
    
    443.41
    
    
    
    197.85
    
    
    
    215.50
    
    
    
    704.45
    
    
    
    704.91
    
    
    
    307.96
    
    
    
    106.65
    
    
    
    92.9903
    
    
    1,202.94
    
    
    
    204.59
    
    
    
    111.32
    
    
    
    68.51
    
    
    
    143.24
    
    
    
    78.09
    
    
    
    282.55
    
    
    
    171.44
    
    
    
    357.68
    
    
    
    11,294.47
    
    
    
    1,682.98
    
    
    
    493.13
    
    
    
    225.18
    
    
    
    244.90
    
    
    
    798.83
    
    
    
    802.86
    
    
    
    343.26
    
    
    
    107.89
    
    
    
    93.0904
    
    
    1,053.63
    
    
    
    179.95
    
    
    
    98.04
    
    
    
    60.87
    
    
    
    125.84
    
    
    
    69.17
    
    
    
    249.28
    
    
    
    151.74
    
    
    
    318.64
    
    
    
    10,821.52
    
    
    
    1,612.23
    
    
    
    473.28
    
    
    
    217.37
    
    
    
    235.24
    
    
    
    767.60
    
    
    
    773.60
    
    
    
    299.76
    
    
    
    104.38
    
    
    
    91.0205
    
    
    1,197.86
    
    
    
    203.95
    
    
    
    110.96
    
    
    
    68.53
    
    
    
    142.22
    
    
    
    77.82
    
    
    
    281.53
    
    
    
    170.94
    
    
    
    358.14
    
    
    
    12,069.53
    
    
    
    1,786.50
    
    
    
    523.94
    
    
    
    238.76
    
    
    
    257.40
    
    
    
    841.90
    
    
    
    848.05
    
    
    
    227.76
    
    
    
    93.64
    
    
    
    82.9106
    
    
    1,042.12
    
    
    
    179.03
    
    
    
    97.75
    
    
    
    61.27
    
    
    
    125.43
    
    
    
    69.41
    
    
    
    249.34
    
    
    
    152.33
    
    
    
    322.31
    
    
    
    11,001.15
    
    
    
    1,637.46
    
    
    
    480.92
    
    
    
    222.02
    
    
    
    238.67
    
    
    
    780.44
    
    
    
    787.91
    
    
    
    275.82
    
    
    
    89.31
    
    
    
    78.7007
    
    
    1,078.10
    
    
    
    184.64
    
    
    
    100.74
    
    
    
    62.77
    
    
    
    129.04
    
    
    
    71.12
    
    
    
    256.28
    
    
    
    156.19
    
    
    
    328.97
    
    
    
    11,641.41
    
    
    
    1,737.22
    
    
    
    510.18
    
    
    
    236.58
    
    
    
    255.22
    
    
    
    832.03
    
    
    
    841.03
    
    
    
    372.84
    
    
    
    95.02
    
    
    
    83.9608
    
    
    1,020.93
    
    
    
    175.38
    
    
    
    95.83
    
    
    
    59.82
    
    
    
    123.02
    
    
    
    68.16
    
    
    
    244.21
    
    
    
    149.16
    
    
    
    314.87
    
    
    
    10,382.50
    
    
    
    1,548.29
    
    
    
    454.25
    
    
    
    208.76
    
    
    
    226.37
    
    
    
    738.04
    
    
    
    743.69
    
    
    
    257.66
    
    
    
    91.95
    
    
    
    80.3409
    
    
    1,054.44
    
    
    
    179.75
    
    
    
    97.91
    
    
    
    60.47
    
    
    
    125.80
    
    
    
    68.74
    
    
    
    248.60
    
    
    
    151.17
    
    
    
    316.19
    
    
    
    10,926.41
    
    
    
    1,632.73
    
    
    
    479.08
    
    
    
    222.24
    
    
    
    239.31
    
    
    
    782.08
    
    
    
    789.08
    
    
    
    221.97
    
    
    
    98.50
    
    
    
    85.8710
    
    
    1,067.77
    
    
    
    183.66
    
    
    
    100.44
    
    
    
    63.06
    
    
    
    128.58
    
    
    
    71.37
    
    
    
    255.90
    
    
    
    156.45
    
    
    
    332.07
    
    
    
    14,123.37
    
    
    
    2,112.61
    
    
    
    622.03
    
    
    
    293.66
    
    
    
    312.81
    
    
    
    1,022.63
    
    
    
    1,038.05
    
    
    
    321.88
    
    
    
    104.53
    
    
    
    92.5411
    
    
    1,351.63
    
    
    
    229.37
    
    
    
    124.54
    
    
    
    76.50
    
    
    
    159.68
    
    
    
    86.73
    
    
    
    315.49
    
    
    
    190.99
    
    
    
    399.28
    
    
    
    14,265.85
    
    
    
    2,112.87
    
    
    
    620.88
    
    
    
    285.88
    
    
    
    306.86
    
    
    
    1,001.06
    
    
    
    1,010.17
    
    
    
    369.15
    
    
    
    150.09
    
    
    
    132.326B*
    
    
    1,041.98
    
    
    
    179.01
    
    
    
    97.74
    
    
    
    61.26
    
    
    
    125.41
    
    
    
    69.40
    
    
    
    249.31
    
    
    
    152.31
    
    
    
    322.26
    
    
    
    11,000.66
    
    
    
    1,637.38
    
    
    
    480.90
    
    
    
    222.01
    
    
    
    238.66
    
    
    
    780.39
    
    
    
    787.88
    
    
    
    275.82
    
    
    
    89.31
    
    
    
    78.70
 TABLE 6
 General + Dental Rates:
 TANF
    
    
    
    
    
    
    
    
    
    
    
    
    
    AGE (14-20)
    
    
    
    
    
    AGE (21-54)
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-N
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-ABArea
    
    BTHM0+2M0
    
    3M0.11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    Female
    
    Male
    
    Female
    
    Male
    
    AGE (55+)
    
    BTHMO+2M0
    
    3M0-11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    AGE (14-20)
    
    AGE (21-54)
    
    AGE (55+)
    
    SSI-B
    
    AGE (65-)
    
    AGE (65+)01
    
    
    1,094.22
    
    
    
    184.17
    
    
    
    101.28
    
    
    
    63.46
    
    
    
    130.39
    
    
    
    70.96
    
    
    
    252.04
    
    
    
    151.97
    
    
    
    315.77
    
    
    
    10,249.54
    
    
    
    1,491.48
    
    
    
    439.80
    
    
    
    197.82
    
    
    
    211.50
    
    
    
    686.05
    
    
    
    690.10
    
    
    
    301.06
    
    
    
    94.27
    
    
    
    85.1502
    
    
    1,094.22
    
    
    
    184.17
    
    
    
    101.28
    
    
    
    63.46
    
    
    
    130.39
    
    
    
    70.96
    
    
    
    252.04
    
    
    
    151.97
    
    
    
    315.77
    
    
    
    10,249.54
    
    
    
    1,491.48
    
    
    
    439.80
    
    
    
    197.82
    
    
    
    211.50
    
    
    
    686.05
    
    
    
    690.10
    
    
    
    301.06
    
    
    
    94.27
    
    
    
    85.1503
    
    
    1,196.63
    
    
    
    202.98
    
    
    
    113.34
    
    
    
    73.48
    
    
    
    146.51
    
    
    
    81.31
    
    
    
    280.36
    
    
    
    170.22
    
    
    
    357.43
    
    
    
    11,246.01
    
    
    
    1,651.17
    
    
    
    489.64
    
    
    
    226.72
    
    
    
    241.23
    
    
    
    775.81
    
    
    
    784.47
    
    
    
    335.71
    
    
    
    90.08
    
    
    
    81.8104
    
    
    1,049.15
    
    
    
    178.80
    
    
    
    99.15
    
    
    
    63.81
    
    
    
    127.57
    
    
    
    70.94
    
    
    
    248.15
    
    
    
    151.33
    
    
    
    319.44
    
    
    
    10,783.85
    
    
    
    1,587.50
    
    
    
    469.94
    
    
    
    217.62
    
    
    
    231.57
    
    
    
    750.13
    
    
    
    759.88
    
    
    
    294.84
    
    
    
    90.36
    
    
    
    82.1705
    
    
    1,194.07
    
    
    
    202.99
    
    
    
    113.72
    
    
    
    74.40
    
    
    
    147.14
    
    
    
    82.25
    
    
    
    282.54
    
    
    
    172.61
    
    
    
    363.31
    
    
    
    12,038.27
    
    
    
    1,765.99
    
    
    
    523.85
    
    
    
    242.97
    
    
    
    257.80
    
    
    
    829.50
    
    
    
    839.62
    
    
    
    224.92
    
    
    
    83.52
    
    
    
    76.8406
    
    
    1,038.40
    
    
    
    178.08
    
    
    
    99.79
    
    
    
    65.79
    
    
    
    128.98
    
    
    
    72.69
    
    
    
    248.88
    
    
    
    152.48
    
    
    
    324.09
    
    
    
    10,970.19
    
    
    
    1,617.14
    
    
    
    479.71
    
    
    
    224.52
    
    
    
    237.62
    
    
    
    767.02
    
    
    
    777.95
    
    
    
    271.94
    
    
    
    80.16
    
    
    
    73.0607
    
    
    1,074.15
    
    
    
    183.64
    
    
    
    102.48
    
    
    
    66.77
    
    
    
    132.00
    
    
    
    73.89
    
    
    
    255.14
    
    
    
    155.66
    
    
    
    329.37
    
    
    
    11,607.26
    
    
    
    1,714.81
    
    
    
    508.51
    
    
    
    238.83
    
    
    
    253.62
    
    
    
    816.03
    
    
    
    828.38
    
    
    
    368.02
    
    
    
    84.59
    
    
    
    77.4208
    
    
    1,015.74
    
    
    
    174.06
    
    
    
    98.59
    
    
    
    65.95
    
    
    
    127.80
    
    
    
    72.58
    
    
    
    243.00
    
    
    
    148.75
    
    
    
    315.98
    
    
    
    10,344.94
    
    
    
    1,523.64
    
    
    
    452.53
    
    
    
    211.41
    
    
    
    224.78
    
    
    
    721.02
    
    
    
    730.55
    
    
    
    253.34
    
    
    
    79.05
    
    
    
    72.2309
    
    
    1,049.43
    
    
    
    178.47
    
    
    
    100.00
    
    
    
    65.35
    
    
    
    129.35
    
    
    
    72.10
    
    
    
    246.44
    
    
    
    149.77
    
    
    
    315.05
    
    
    
    10,887.75
    
    
    
    1,607.34
    
    
    
    476.39
    
    
    
    223.61
    
    
    
    236.51
    
    
    
    763.41
    
    
    
    773.95
    
    
    
    217.32
    
    
    
    84.02
    
    
    
    76.6710
    
    
    1,064.84
    
    
    
    182.90
    
    
    
    102.37
    
    
    
    67.21
    
    
    
    131.99
    
    
    
    74.46
    
    
    
    254.81
    
    
    
    155.81
    
    
    
    331.77
    
    
    
    14,097.57
    
    
    
    2,095.68
    
    
    
    621.28
    
    
    
    296.13
    
    
    
    312.27
    
    
    
    1,010.33
    
    
    
    1,028.19
    
    
    
    317.48
    
    
    
    93.68
    
    
    
    85.6911
    
    
    1,348.60
    
    
    
    228.60
    
    
    
    127.74
    
    
    
    83.76
    
    
    
    166.35
    
    
    
    92.56
    
    
    
    314.46
    
    
    
    190.42
    
    
    
    399.21
    
    
    
    14,238.95
    
    
    
    2,095.23
    
    
    
    621.44
    
    
    
    291.47
    
    
    
    309.00
    
    
    
    989.01
    
    
    
    1,000.97
    
    
    
    367.40
    
    
    
    139.98
    
    
    
    126.076B*
    
    
    1,038.26
    
    
    
    178.06
    
    
    
    99.78
    
    
    
    65.78
    
    
    
    128.96
    
    
    
    72.68
    
    
    
    247.00
    
    
    
    150.55
    
    
    
    319.81
    
    
    
    10,969.71
    
    
    
    1,617.06
    
    
    
    479.69
    
    
    
    224.51
    
    
    
    237.61
    
    
    
    764.51
    
    
    
    774.47
    
    
    
    271.94
    
    
    
    80.16
    
    
    
    73.06
 AHCA Contract No. FA614, Exhibit III-F, Page 3 of 5




---



##### 



EXHIBIT III-F
March 1, 2009  August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009
 TABLE 7
 General + Dental + Transportation Rates:
 TANF
    
    
    
    
    
    
    
    
    
    
    
    
    
    AGE (14-20)
    
    
    
    
    
    AGE (21.54)
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-N
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-ABArea
    
    BTHM0+2M0
    
    3M0.11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    Female
    
    Male
    
    Female
    
    Male
    
    AGE (55+)
    
    BTHMO+2M0
    
    3M0-11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    AGE (14-20)
    
    AGE (21-54)
    
    AGE (55+)
    
    SSI-B
    
    AGE (65-)
    
    AGE (65+)01
    
    
    1,099.48
    
    
    
    185.52
    
    
    
    102.10
    
    
    
    63.95
    
    
    
    132.39
    
    
    
    72.28
    
    
    
    255.28
    
    
    
    154.44
    
    
    
    319.22
    
    
    
    10,287.96
    
    
    
    1,516.71
    
    
    
    445.00
    
    
    
    200.21
    
    
    
    217.52
    
    
    
    705.76
    
    
    
    706.74
    
    
    
    308.40
    
    
    
    107.75
    
    
    
    93.8402
    
    
    1,099.48
    
    
    
    185.52
    
    
    
    102.10
    
    
    
    63.95
    
    
    
    132.39
    
    
    
    72.28
    
    
    
    255.28
    
    
    
    154.44
    
    
    
    319.22
    
    
    
    10,287.96
    
    
    
    1,516.71
    
    
    
    445.00
    
    
    
    200.21
    
    
    
    217.52
    
    
    
    705.76
    
    
    
    706.74
    
    
    
    308.40
    
    
    
    107.75
    
    
    
    93.8403
    
    
    1,202.95
    
    
    
    204.61
    
    
    
    114.32
    
    
    
    74.07
    
    
    
    148.91
    
    
    
    82.89
    
    
    
    284.26
    
    
    
    173.19
    
    
    
    361.58
    
    
    
    11,294.47
    
    
    
    1,682.99
    
    
    
    496.21
    
    
    
    229.74
    
    
    
    248.82
    
    
    
    800.68
    
    
    
    805.46
    
    
    
    344.27
    
    
    
    109.51
    
    
    
    94.3304
    
    
    1,053.64
    
    
    
    179.96
    
    
    
    99.85
    
    
    
    64.23
    
    
    
    129.28
    
    
    
    72.07
    
    
    
    250.92
    
    
    
    153.43
    
    
    
    322.39
    
    
    
    10,821.52
    
    
    
    1,612.23
    
    
    
    475.03
    
    
    
    219.96
    
    
    
    237.47
    
    
    
    769.45
    
    
    
    776.19
    
    
    
    301.90
    
    
    
    105.94
    
    
    
    92.2105
    
    
    1,197.87
    
    
    
    203.97
    
    
    
    114.31
    
    
    
    74.75
    
    
    
    148.58
    
    
    
    83.20
    
    
    
    284.88
    
    
    
    174.39
    
    
    
    365.80
    
    
    
    12,069.54
    
    
    
    1,786.51
    
    
    
    528.09
    
    
    
    244.92
    
    
    
    262.69
    
    
    
    845.54
    
    
    
    853.16
    
    
    
    231.36
    
    
    
    97.36
    
    
    
    85.7506
    
    
    1,042.13
    
    
    
    179.04
    
    
    
    100.37
    
    
    
    66.14
    
    
    
    130.40
    
    
    
    73.62
    
    
    
    251.19
    
    
    
    154.24
    
    
    
    326.54
    
    
    
    11,001.15
    
    
    
    1,637.47
    
    
    
    483.91
    
    
    
    226.44
    
    
    
    242.47
    
    
    
    782.90
    
    
    
    791.36
    
    
    
    277.55
    
    
    
    91.52
    
    
    
    80.3807
    
    
    1,078.11
    
    
    
    184.65
    
    
    
    103.10
    
    
    
    67.14
    
    
    
    133.50
    
    
    
    74.89
    
    
    
    257.59
    
    
    
    157.53
    
    
    
    331.96
    
    
    
    11,641.41
    
    
    
    1,737.23
    
    
    
    513.13
    
    
    
    240.94
    
    
    
    258.97
    
    
    
    833.55
    
    
    
    843.17
    
    
    
    373.31
    
    
    
    96.51
    
    
    
    85.1008
    
    
    1,020.94
    
    
    
    175.40
    
    
    
    99.41
    
    
    
    66.44
    
    
    
    129.79
    
    
    
    73.89
    
    
    
    246.20
    
    
    
    151.19
    
    
    
    319.39
    
    
    
    10,382.50
    
    
    
    1,548.30
    
    
    
    457.61
    
    
    
    213.75
    
    
    
    230.66
    
    
    
    740.28
    
    
    
    746.83
    
    
    
    259.17
    
    
    
    93.59
    
    
    
    81.5909
    
    
    1,054.45
    
    
    
    179.77
    
    
    
    100.79
    
    
    
    65.82
    
    
    
    131.26
    
    
    
    73.36
    
    
    
    249.54
    
    
    
    152.13
    
    
    
    318.34
    
    
    
    10,926.41
    
    
    
    1,632.74
    
    
    
    481.63
    
    
    
    226.02
    
    
    
    242.56
    
    
    
    783.24
    
    
    
    790.70
    
    
    
    223.77
    
    
    
    99.55
    
    
    
    86.6710
    
    
    1,067.78
    
    
    
    183.67
    
    
    
    102.83
    
    
    
    67.49
    
    
    
    133.11
    
    
    
    75.20
    
    
    
    256.62
    
    
    
    157.19
    
    
    
    333.70
    
    
    
    14,123.37
    
    
    
    2,112.62
    
    
    
    624.77
    
    
    
    297.73
    
    
    
    316.31
    
    
    
    1,023.56
    
    
    
    1,039.36
    
    
    
    322.69
    
    
    
    105.81
    
    
    
    93.5011
    
    
    1,351.64
    
    
    
    229.38
    
    
    
    128.21
    
    
    
    84.05
    
    
    
    167.51
    
    
    
    93.33
    
    
    
    316.34
    
    
    
    191.85
    
    
    
    401.21
    
    
    
    14,265.86
    
    
    
    2,112.89
    
    
    
    625.08
    
    
    
    293.14
    
    
    
    313.22
    
    
    
    1,002.81
    
    
    
    1,012.63
    
    
    
    372.43
    
    
    
    152.21
    
    
    
    133.946B*
    
    
    1,041.99
    
    
    
    179.02
    
    
    
    100.36
    
    
    
    66.13
    
    
    
    130.38
    
    
    
    73.61
    
    
    
    249.31
    
    
    
    152.31
    
    
    
    322.26
    
    
    
    11,000.66
    
    
    
    1,637.39
    
    
    
    483.89
    
    
    
    226.43
    
    
    
    242.46
    
    
    
    780.39
    
    
    
    787.88
    
    
    
    277.55
    
    
    
    91.52
    
    
    
    80.38
 TABLE 8
 General + Mental Health + Dental + Transportation Rates:
 TANF
    
    
    
    
    
    
    
    
    
    
    
    
    
    AGE (14-20)
    
    
    
    
    
    AGE (21-54)
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-N
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    SSI-ABArea
    
    BTHM0+2M0
    
    3M0.11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    Female
    
    Male
    
    Female
    
    Male
    
    AGE (55+)
    
    BTHMO+2M0
    
    3M0-11MO
    
    AGE (1-5)
    
    AGE (6-13)
    
    AGE (14-20)
    
    AGE (21-54)
    
    AGE (55+)
    
    SSI-B
    
    AGE (65-)
    
    AGE (65+)01
    
    
    1,099.50
    
    
    
    185.54
    
    
    
    103.71
    
    
    
    75.44
    
    
    
    143.13
    
    
    
    83.02
    
    
    
    259.64
    
    
    
    158.80
    
    
    
    322.90
    
    
    
    10,288.04
    
    
    
    1,516.79
    
    
    
    452.31
    
    
    
    247.43
    
    
    
    260.75
    
    
    
    785.76
    
    
    
    737.19
    
    
    
    308.61
    
    
    
    119.20
    
    
    
    105.2902
    
    
    1,099.51
    
    
    
    185.55
    
    
    
    104.96
    
    
    
    83.86
    
    
    
    145.58
    
    
    
    85.47
    
    
    
    258.63
    
    
    
    157.79
    
    
    
    322.12
    
    
    
    10,288.11
    
    
    
    1,516.86
    
    
    
    458.56
    
    
    
    277.67
    
    
    
    261.96
    
    
    
    787.53
    
    
    
    731.19
    
    
    
    328.26
    
    
    
    122.50
    
    
    
    108.5903
    
    
    1,202.96
    
    
    
    204.62
    
    
    
    115.62
    
    
    
    83.09
    
    
    
    154.89
    
    
    
    88.87
    
    
    
    285.78
    
    
    
    174.71
    
    
    
    362.90
    
    
    
    11,294.54
    
    
    
    1,683.06
    
    
    
    502.36
    
    
    
    264.88
    
    
    
    268.98
    
    
    
    824.17
    
    
    
    816.55
    
    
    
    351.00
    
    
    
    118.34
    
    
    
    103.1604
    
    
    1,053.65
    
    
    
    179.97
    
    
    
    101.20
    
    
    
    73.62
    
    
    
    135.51
    
    
    
    78.30
    
    
    
    252.50
    
    
    
    155.01
    
    
    
    323.76
    
    
    
    10,821.63
    
    
    
    1,612.34
    
    
    
    484.62
    
    
    
    274.74
    
    
    
    268.90
    
    
    
    806.07
    
    
    
    793.48
    
    
    
    326.03
    
    
    
    122.42
    
    
    
    108.6905
    
    
    1,197.88
    
    
    
    203.98
    
    
    
    115.50
    
    
    
    83.28
    
    
    
    156.55
    
    
    
    91.17
    
    
    
    288.12
    
    
    
    177.63
    
    
    
    368.53
    
    
    
    12,069.59
    
    
    
    1,786.56
    
    
    
    533.03
    
    
    
    276.78
    
    
    
    291.86
    
    
    
    899.51
    
    
    
    873.70
    
    
    
    234.04
    
    
    
    109.96
    
    
    
    98.3506
    
    
    1,042.15
    
    
    
    179.06
    
    
    
    102.19
    
    
    
    79.16
    
    
    
    142.56
    
    
    
    85.78
    
    
    
    256.13
    
    
    
    159.18
    
    
    
    330.71
    
    
    
    11,001.22
    
    
    
    1,637.54
    
    
    
    490.32
    
    
    
    267.82
    
    
    
    280.35
    
    
    
    853.00
    
    
    
    818.04
    
    
    
    278.84
    
    
    
    95.34
    
    
    
    84.2007
    
    
    1,078.13
    
    
    
    184.67
    
    
    
    104.85
    
    
    
    79.61
    
    
    
    145.15
    
    
    
    86.54
    
    
    
    262.33
    
    
    
    162.27
    
    
    
    335.96
    
    
    
    11,641.47
    
    
    
    1,737.29
    
    
    
    519.15
    
    
    
    279.77
    
    
    
    294.52
    
    
    
    899.33
    
    
    
    868.21
    
    
    
    375.86
    
    
    
    106.85
    
    
    
    95.4408
    
    
    1,020.95
    
    
    
    175.41
    
    
    
    100.65
    
    
    
    75.08
    
    
    
    135.51
    
    
    
    79.61
    
    
    
    247.66
    
    
    
    152.65
    
    
    
    320.65
    
    
    
    10,382.57
    
    
    
    1,548.37
    
    
    
    463.51
    
    
    
    247.44
    
    
    
    250.00
    
    
    
    762.80
    
    
    
    757.46
    
    
    
    265.90
    
    
    
    106.58
    
    
    
    94.5809
    
    
    1,054.47
    
    
    
    179.79
    
    
    
    102.31
    
    
    
    76.44
    
    
    
    138.29
    
    
    
    80.39
    
    
    
    251.33
    
    
    
    153.92
    
    
    
    319.89
    
    
    
    10,926.48
    
    
    
    1,632.81
    
    
    
    487.85
    
    
    
    261.54
    
    
    
    262.95
    
    
    
    806.98
    
    
    
    801.91
    
    
    
    230.50
    
    
    
    108.97
    
    
    
    96.0910
    
    
    1,067.80
    
    
    
    183.69
    
    
    
    104.72
    
    
    
    80.62
    
    
    
    141.81
    
    
    
    83.90
    
    
    
    258.83
    
    
    
    159.40
    
    
    
    335.62
    
    
    
    14,123.46
    
    
    
    2,112.71
    
    
    
    632.98
    
    
    
    344.62
    
    
    
    343.22
    
    
    
    1,054.90
    
    
    
    1,054.16
    
    
    
    329.42
    
    
    
    113.73
    
    
    
    101.4211
    
    
    1,351.66
    
    
    
    229.40
    
    
    
    129.80
    
    
    
    95.15
    
    
    
    174.87
    
    
    
    100.69
    
    
    
    318.21
    
    
    
    193.72
    
    
    
    402.83
    
    
    
    14,265.94
    
    
    
    2,112.97
    
    
    
    631.93
    
    
    
    322.26
    
    
    
    335.66
    
    
    
    1,028.95
    
    
    
    1,024.97
    
    
    
    379.53
    
    
    
    160.13
    
    
    
    141.866B*
    
    
    1,042.01
    
    
    
    179.04
    
    
    
    102.08
    
    
    
    78.43
    
    
    
    141.87
    
    
    
    85.10
    
    
    
    253.98
    
    
    
    156.98
    
    
    
    326.20
    
    
    
    11,000.73
    
    
    
    1,637.46
    
    
    
    490.28
    
    
    
    267.69
    
    
    
    280.23
    
    
    
    850.29
    
    
    
    814.48
    
    
    
    278.84
    
    
    
    95.34
    
    
    
    84.20
 AHCA Contract No. FA614, Exhibit III-F, Page 4 of 5




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##### 



EXHIBIT III-F
March 1, 2009  August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009
 Area
    
    Corresponding CountiesArea 1
    
    Escambia, Okaloosa, Santa Rosa, WaltonArea 2
    
    Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, WakullaArea 3
    
    Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marlon, Putnam, Sumter, Suwannee, UnionArea 4
    
    Baker, Clay, Duval, Flagler, Nassau, St. Johns, VolusiaArea 5
    
    Pasco, PinellasArea 6
    
    Hardee, Highlands, Hillsborough, Manatee, PolkArea 7
    
    Brevard, Orange, Osceola, SeminoleArea 8
    
    Charlotte, Collier, De Soto, Glades, Hendry, Lee, SarasotaArea 9
    
    Indian River, Okeechobee, St. Lucie, Martin, Palm BeachArea 10
    
    BrowardArea 11
    
    Dade, Monroe
 AHCA Contract No. FA614, Exhibit III-F, Page 5 of 5