EX-10.2






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



AHCA CONTRACT NO. FA614




AMENDMENT NO. 6




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. Effective September 1, 2007, Attachment I, Scope of Services, is hereby
amended to include Exhibit III-B, 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-A, September 1, 2007 — August 31, 2008 Medicaid Non-Reform HMO Rates,
shall hereinafter instead refer to Exhibit III-B, September 1, 2007- August 31, 2008 Medicaid
Non-Reform HMO Capitation Rates, as appropriate.





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.



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

BY:

	 	 	 	SIGNED

BY:
	NAME:William McHugh .......................
	 	NAME:Andrew C. Agwunobi, M.D
	 
	 	 
	TITLE: CEO

	 	 	 	TITLE:Secretary
	 

	 	 	 	 
	DATE:

	 	 	 	DATE:
	List of attachments included as part of this Amendment:

	Specify

Type

	 	Letter/Number

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

Description
	 

	 	 
	 	 
	Exhibit

	 	III-B
	 	September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO






Capitation Rates (5 Pages)



AHCA Contract No. FA614, Amendment No. 4, Page 1 of 1




1





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



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:

	 	

	 	

	 	

	 	

	
 
	 	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	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	011,131.99202.30

021,131.99202.30

31,296.42233.58

041,128.87203.75

051,260.50227.66

061,111.64201.87

071,129.81204.44

081,059.95192.36

091,098.82197.96

101,119.46203.01

111,448.96260.41

	 	105.58

105.58

122.13

106.78

119.09

106.04

107.10

100.83

103.63

106.51

136.24
	 	66.22

66.22

77.48

67.92

75.94

68.10

68.40

64.75

65.91

68.32

86.18
	 	135.19

135.19

156.47

136.68

152.59

135.60

137.11

129.15

132.56

136.20

174.38
	 	72.29

72.29

84.50

74.01

82.61

74.02

74.43

70.40

71.62

74.23

94.02
	 	265.45

265.45

308.68

269.88

301.42

269.07

271.08

255.88

261.85

270.06

343.72
	 	167.89

167.89

196.24

171.79

191.81

171.81

172.77

163.25

166.57

172.18

218.26
	 	347.47

347.47

408.68

358.59

400.30

360.32

361.05

342.35

346.99

360.84

453.77
	 	10,081.87

10,081.87

11,326.29

10,675.98

11,774.49

10,832.05

11,163.75

9,491.26

10,597.24

13,743.01

14,396.52
	 	1,458.88

1,458.88

1,656.79

1,563.58

1,721.01

1,590.31

1,640.70

1,388.78

1,556.56

2,028.53

2,111.55
	 	435.95

435.95

495.12

467.86

514.94

475.95

490.80

415.62

465.60

606.68

631.62
	 	201.26

201.26

233.33

220.87

241.96

225.91

233.68

196.24

221.41

290.75

299.15
	 	222.08

222.08

256.55

242.36

266.53

247.84

256.10

215.38

242.54

319.15

329.01
	 	716.10

716.10

826.59

781.86

857.42

799.09

824.52

694.16

781.98

1,026.77

1,058.44
	 	703.88

703.88

816.63

772.10

846.21

790.01

815.86

685.42

773.10

1,016.73

1,046.51
	 	270.05

270.05

272.84

329.54

228.63

283.50

326.33

190.94

204.68

255.52

335.29
	 	98.2880.72

98.2880.72

91.4075.41

94.1977.67

88.3873.66

85.4570.71

88.9173.77

84.4169.83

91.8076.03

105.0486.99

159.90130.52
	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

	 	1,132.01

1,132.02

1,296.43

1,128.88

1,260.51

1,111.66

1,129.83

1,059.96

1,098.84

1,119.48

1,448.98
	 	202.32

202.33

233.59

203.76

227.67

201.89

204.46

192.37

197.98

203.03

260.43
	 	107.22

108.49

123.45

108.15

120.30

107.89

108.88

102.09

105.18

108.43

137.86
	 	77.91

86.47

86.66

77.48

84.61

81.34

81.08

73.55

76.72

81.68

97.47
	 	146.11

148.60

162.55

143.01

160.70

147.98

148.96

134.98

139.72

145.05

181.86
	 	83.21

85.70

90.58

80.34

90.72

86.40

86.28

76.23

78.78

83.08

101.50
	 	269.89

268.86

310.23

271.49

304.71

274.10

275.90

257.36

263.67

272.31

345.62
	 	172.33

171.30

197.79

173.40

195.10

176.84

177.59

164.73

168.39

174.43

220.16
	 	351.22

350.43

410.02

359.98

403.08

364.57

365.12

343.63

348.57

362.79

455.42
	 	10,081.95

10,082.03

11,326.36

10,676.09

11,774.54

10,832.12

11,163.81

9,491.33

10,597.31

13,743.10

14,396.60
	 	1,458.96

1,459.04

1,656.86

1,563.69

1,721.06

1,590.38

1,640.76

1,388.85

1,556.63

2,028.62

2,111.63
	 	443.39

449.74

501.38

477.61

519.96

482.47

496.92

421.62

471.93

615.03

638.59
	 	249.30

280.06

269.08

276.60

274.37

268.01

273.18

230.52

257.55

338.45

338.94
	 	266.06

267.29

277.06

274.33

296.20

286.38

292.26

235.05

263.28

346.52

351.84
	 	797.48

768.77

850.48

819.11

912.32

870.40

891.44

717.07

806.13

1,058.65

1,085.04
	 	734.86

728.75

827.91

789.69

867.11

817.15

841.33

696.24

784.51

1,031.78

1,059.07
	 	271.05

291.04

279.47

354.09

231.36

284.81

328.92

197.79

211.53

262.37

342.52
	 	109.93

113.28

100.38

110.96

101.19

89.33

99.42

97.63

101.39

113.09

167.95
	 	92.37

95.72

84.39

94.44

86.47

74.59

84.28

83.05

85.62

95.04

138.57






2





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



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 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	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	011,132.02202.33109.31

021,132.03202.34110.58

031,296.44233.60126.52

041,128.89203.77110.20

051,260.52227.69123.77

061,111.67201.90110.53

071,129.84204.47111.04

081,059.97192.38105.11

091,098.85197.99108.10

101,119.49203.04111.29

111,448.99260.44141.58

	 	82.23

90.79

93.00

81.71

91.76

86.79

85.54

79.80

82.75

87.56

105.13
	 	150.59

153.08

169.14

147.39

168.12

153.63

153.58

141.46

145.98

151.15

189.81
	 	86.99

89.48

96.13

84.03

96.98

91.17

90.17

81.69

84.06

88.23

108.20
	 	271.74

270.71

313.24

274.30

311.90

277.72

278.43

260.37

264.42

274.13

347.23
	 	173.97

172.94

200.46

175.89

201.49

180.05

179.84

167.40

169.94

176.05

221.59
	 	354.63

353.84

415.57

365.17

416.36

371.26

369.79

349.19

351.80

366.16

458.40
	 	10,081.95

10,082.03

11,326.37

10,676.09

11,774.55

10,832.13

11,163.81

9,491.34

10,597.31

13,743.11

14,396.61
	 	1,458.97

1,459.05

1,656.88

1,563.70

1,721.08

1,590.40

1,640.77

1,388.87

1,556.64

2,028.64

2,111.65
	 	445.59

451.94

504.76

479.82

524.88

485.64

500.03

424.74

474.66

618.77

642.83
	 	253.12269.40

283.88270.63

274.93282.17

280.43277.68

282.89303.65

273.51291.19

278.58296.97

235.93239.77

262.28267.41

344.93352.19

346.28358.26
	 	800.35

771.64

854.04

822.42

919.87

874.82

894.55

720.67

807.81

1,060.76

1,088.67
	 	738.28

732.17

832.15

793.64

876.10

822.42

845.04

700.54

786.52

1,034.30

1,063.40
	 	271.55

291.54

280.01

356.10

235.79

286.65

330.54

199.27

212.26

264.42

346.92
	 	112.24

115.59

103.46

114.04

109.53

94.11

102.58

100.78

103.23

115.66

172.01
	 	93.85

97.20

86.37

96.42

91.82

77.66

86.31

85.06

86.80

96.69

141.17
	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

	 	1,137.56

1,137.57

1,303.13

1,133.91

1,264.71

1,115.71

1.133.77

1,065.54

1,104.22

1,123.27

1,452.24
	 	203.71

203.72

235.26

205.01

228.72

202.90

205.44

193.77

199.32

203.97

261.24
	 	108.08

109.35

124.49

108.93

120.95

108.52

109.49

102.95

106.02

109.01

138.36
	 	78.43

86.99

87.29

77.95

85.01

81.72

81.45

74.07

77.23

82.04

97.78
	 	148.03

150.52

164.87

144.75

162.15

149.38

150.32

136.91

141.58

146.35

182.98
	 	84.47

86.96

92.09

81.48

91.67

87.31

87.17

77.49

79.99

83.94

102.24
	 	272.98

271.95

313.95

274.28

307.04

276.35

278.09

260.46

266.66

274.42

347.43
	 	174.71

173.68

200.67

175.56

196.90

178.58

179.28

167.12

170.70

176.05

221.56
	 	354.40

353.61

413.86

362.87

405.49

366.89

367.38

346.83

351.65

364.96

457.29
	 	10,125.36

10,125.44

11,381.17

10,720.46

11,809.84

10,866.95

11,201.13

9,532.67

10,640.50

13,782.23

14,425.98
	 	1,486.99

1,487.07

1,692.25

1,592.34

1,743.85

1,612.87

1,664.85

1,415.54

1,584.51

2,053.89

2,130.60
	 	449.03

455.38

508.50

483.38

524.54

487.00

501.77

427.00

477.55

620.11

642.40
	 	251.78

282.54

272.20

279.13

276.38

270.00

275.30

232.88

260.02

340.69

340.62
	 	272.18

273.41

284.79

280.59

301.18

291.30

297.53

240.88

269.38

352.05

355.99
	 	817.47

788.76

875.73

839.55

928.58

886.44

908.63

736.11

826.01

1,076.67

1,098.57
	 	751.37

745.26

848.76

806.56

880.53

830.40

855.51

711.96

800.93

1,046.66

1,070.25
	 	277.82

297.81

288.09

361.06

237.24

290.13

334.56

203.87

218.45

269.67

347.44
	 	123.66

127.01

120.22

126.74

115.22

100.93

111.55

112.43

117.20

130.75

180.46
	 	101.13

104.48

97.05

104.50

95.42

81.99

92.03

92.50

95.70

106.30

146.55






3





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



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 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	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	011,137.54203.69

021,137.54203.69

031,303.12235.25

041,133.90205.00

051,264.70228.71

061,115.69202.88

071,133.75205.42

081,065.53193.76

091,104.20199.30

101,123.25203.95

111,452.22261.22

	 	106.44

106.44

123.17

107.56

119.74

106.67

107.71

101.69

104.47

107.09

136.74
	 	66.74

66.74

78.11

68.39

76.34

68.48

68.77

65.27

66.42

68.68

86.49
	 	137.11

137.11

158.79

138.42

154.04

137.00

138.47

131.08

134.42

137.50

175.50
	 	73.55

73.55

86.01

75.15

83.56

74.93

75.32

71.66

72.83

75.09

94.76
	 	268.54

268.54

312.40

272.67

303.75

271.32

273.27

258.98

264.84

272.17

345.53
	 	170.27

170.27

199.12

173.95

193.61

173.55

174.46

165.64

168.88

173.80

219.66
	 	350.65

350.65

412.52

361.48

402.71

362.64

363.31

345.55

350.07

363.01

455.64
	 	10,125.28

10,125.28

11,381.10

10,720.35

11,809.79

10,866.88

11,201.07

9,532.60

10,640.43

13,782.14

14,425.90
	 	1,486.91

1,486.91

1,692.18

1,592.23

1,743.80

1,612.80

1,664.79

1,415.47

1,584.44

2,053.80

2,130.52
	 	441.59

441.59

502.24

473.63

519.52

480.48

495.65

421.00

471.22

611.76

635.43
	 	203.74

203.74

236.45

223.40

243.97

227.90

235.80

198.60

223.88

292.99

300.83
	 	228.20

228.20

264.28

248.62

271.51

252.76

261.37

221.21

248.64

324.68

333.16
	 	736.09

736.09

851.84

802.30

873.68

815.13

841.71

713.20

801.86

1,044.79

1,071.97
	 	720.39

720.39

837.48

788.97

859.63

803.26

830.04

701.14

789.52

1,031.61

1,057.69
	 	277.61

277.61

281.24

336.51

234.51

288.82

331.97

197.02

211.60

262.82

340.21
	 	112.01

112.01

111.24

109.97

102.41

97.05

101.04

99.21

107.61

122.70

172.41
	 	89.48

89.48

88.07

87.73

82.61

78.11

81.52

79.28

86.11

98.25

138.50
	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

	 	1,132.00

1,132.00

1,296.43

1,128.88

1,260.51

1,111.65

1,129.82

1,059.96

1,098.83

1,119.47

1,448.97
	 	202.31

202.31

233.59

203.76

227.68

201.88

204.45

192.37

197.97

203.02

260.42
	 	107.67

107.67

125.20

108.83

122.56

108.68

109.26

103.85

106.55

109.37

139.96
	 	70.54

70.54

83.82

72.15

83.09

73.55

72.86

71.00

71.94

74.20

93.84
	 	139.67

139.67

163.06

141.06

160.01

141.25

141.73

135.63

138.82

142.30

182.33
	 	76.07

76.07

90.05

77.70

88.87

78.79

78.32

75.86

76.90

79.38

100.72
	 	267.30

267.30

311.69

272.69

308.61

272.69

273.61

258.89

263.60

271.88

345.33
	 	169.53

169.53

198.91

174.28

198.20

175.02

175.02

165.92

168.12

173.80

219.69
	 	350.88

350.88

414.23

363.78

413.58

367.01

365.72

347.91

350.22

364.21

456.75
	 	10,081.87

10,081.87

11,326.30

10,675.98

11,774.50

10,832.06

11,163.75

9,491.27

10,597.24

13,743.02

14,396.53
	 	1,458.89

1,458.89

1,656.81

1,563.59

1,721.03

1,590.33

1,640.71

1,388.80

1,556.57

2,028.55

2,111.57
	 	438.15

438.15

498.50

470.07

519.86

479.12

493.91

418.74

468.33

610.42

635.86
	 	205.08

205.08

239.18

224.70

250.48

231.41

239.08

201.65

226.14

297.23

306.49
	 	225.42

225.42

261.66

245.71

273.98

252.65

260.81

220.10

246.67

324.82

335.43
	 	718.97

718.97

830.15

785.17

864.97

803.51

827.63

697.76

783.66

1,028.88

1,062.07
	 	707.30

707.30

820.87

776.05

855.20

795.28

819.57

689.72

775.11

1,019.25

1,050.84
	 	271.34

271.34

273.16

331.51

233.06

285.34

327.95

192.42

205.41

257.57

339.69
	 	100.59

100.59

94.48

97.27

96.72

90.23

92.07

87.56

93.64

107.61

163.96
	 	82.20

82.20

77.39

79.65

79.01

73.78

75.80

71.84

77.21

88.64

133.12






4





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



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 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	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	011,137.55203.70108.5371.06141.59

021,137.55203.70108.5371.06141.59

031,303.13235.26126.2484.45165.38

041,133.91205.01109.6172.62142.80

051,264.71228.73123.2183.49161.46

061,115.70202.89109.3173.93142.65

071,133.76205.43109.8773.23143.09

081,065.54193.77104.7171.52137.56

091,104.21199.31107.3972.45140.68

101,123.26203.96109.9574.56143.60

111,452.23261.23140.4694.15183.45

	 	77.33

77.33

91.56

78.84

89.82

79.70

79.21

77.12

78.11

80.24

101.46
	 	270.39

270.39

315.41

275.48

310.94

274.94

275.80

261.99

266.59

273.99

347.14
	 	171.91

171.91

201.79

176.44

200.00

176.76

176.71

168.31

170.43

175.42

221.09
	 	354.06

354.06

418.07

366.67

415.99

369.33

367.98

351.11

353.30

366.38

458.62
	 	10,125..28

10,125.28

11,381.10

10,720.35

11,809.79

10,866.88

11,201.07

9,532.60

10,640.43

13,782.14

14,425.90
	 	1,486.92

1,486.92

1,692.20

1,592.24

1,743.82

1,612.82

1,664.80

1,415.49

1,584.45

2,053.82

2,130.54
	 	443.79

443.79

505.6

475.84

524.44

483.65

498.76

424.12

473.95

615.50

639.67
	 	203.74

203.74

242.30

227.23

252.49

233.40

241.20

204.01

228.61

299.47

308.17
	 	228.20

228.20

269.39

251.97

278.96

257.57

266.08

225.93

252.77

330.35

339.58
	 	736.09

736.09

855.40

805.61

881.23

819.55

844.82

716.80

803.54

1,046.90

1,075.60
	 	723.81

723.81

841.72

792.92

868.62

808.53

833.75

705.44

791.53

1,034.13

1,062.02
	 	278.11

278.11

281.78

338.52

238.94

290.66

333.59

198.50

212.33

264.87

344.61
	 	114.32

114.32

114.32

113.05

110.75

101.83

104.20

102.36

109.45

125.27

176.47
	 	90.96

90.96

90.05

89.71

87.96

81.18

83.55

81.29

87.29

99.90

141.10
	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

	 	1,137.57

1,137.58

1,303.14

1,133.92

1,264.72

1,115.72

1,133.78

1,065.55

1,104.23

1,123.28

1,452.25
	 	203.72

203.73

235.27

205.02

228.74

202.91

205.45

193.78

199.33

203.98

261.25
	 	110.17

111.44

127.56

110.98

124.42

111.16

111.65

105.97

108.94

111.87

142.08
	 	82.75

91.31

93.63

82.18

92.16

87.17

85.91

80.32

83.26

87.92

105.44
	 	152.51

155.00

171.46

149.13

169.57

155.03

154.94

143.39

147.84

152.45

190.93
	 	88.25

90.74

97.64

85.17

97.93

92.08

91.06

82.95

85.27

89.09

108.94
	 	274.83

273.80

316.96

277.09

314.23

279.97

280.62

263.47

268.41

276.24

349.04
	 	176.35

175.32

203.34

178.05

203.29

181.79

181.53

169.79

172.25

177.67

222.99
	 	357.81

357.02

419.41

368.06

418.77

373.58

372.05

352.39

354.88

368.33

460.27
	 	10,125.36

10,125.44

11,381.18

10,720.46

11,809.85

10,866.96

11,201.13

9,532.68

10,640.50

13,782.24

14,425.99
	 	1,487.00

1,487.08

1,692.27

1,592.35

1,743.87

1,612.89

1,664.86

1,415.56

1,584.52

2,053.91

2,130.62
	 	451.23

457.58

511.88

485.59

529.46

490.17

504.88

430.12

480.28

623.85

646.64
	 	255.60

286.36

278.05

282.96

284.90

275.50

280.70

238.29

264.75

347.17

347.96
	 	275.52

276.75

289.90

283.94

308.63

296.11

302.24

245.60

273.51

357.72

362.41
	 	820.34

791.63

879.29

842.86

936.13

890.86

911.74

739.71

827.69

1,078.78

1,102.20
	 	754.79

748.68

853.00

810.51

889.52

835.67

859.22

716.26

802.94

1,049.18

1,074.58
	 	278.32

298.31

288.63

363.07

241.67

291.97

336.18

205.35

219.18

271.72

351.84
	 	125.97

129.32

123.30

129.82

123.56

105.71

114.71

115.58

119.04

133.32

184.52
	 	102.61

105.96

99.03

106.48

100.77

85.06

94.06

94.51

96.88

107.95

149.15






5




EXHIBIT III-A

September 1, 2007- 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 10, 2007


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




6