Document:

EX-10.1

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

AHCA CONTRACT NO. FA614

AMENDMENT NO. 5

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 $1,082,799,481.00 (an increase of $13,248,088.00), subject to availability of
funds.

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

Notwithstanding the payment amounts which may be computed with the rate tables specified in
Exhibit III, the sum of total capitation payments under this Contract shall not exceed the
total Contract amount of $1,082,799,481.00 (an increase of $13,248,088.00).

	3.	 	Attachment I, Scope of Services is hereby amended to include Exhibit I-C, Third Revised
Maximum Enrollment Levels, attached hereto and made a part of the Contract. All references in
the Contract to Exhibit I-B, Second Revised Maximum Enrollment Levels shall hereinafter also
refer it Exhibit I-C, Third Revised Maximum Enrollment Levels, as appropriate.

	4.	 	Attachment I, Scope of Services is hereby amended to include Exhibit II-E, Fifth Revised
Capitation Rates, attached hereto and made a part of the Contract. All references in the
Contract to Exhibit II-D, Fourth Revised Capitation Rates, shall hereinafter also refer it
Exhibit II-E, Fifth Revised Capitation Rates, as appropriate.

	5.	 	This Amendment shall become effective upon execution by both parties, or December 1, 2007,
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.

AHCA Contract No. FA614, Amendment No. 5, Page 1 of 2

1

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

IN WITNESS WHEREOF, the parties hereto have caused this four (4) 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

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

	 	 	 	TITLE:Secretary
	 

	 	 	 	 
	DATE: 11-29-07

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

	Specify

Type

	 	Letter/Number

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

Description
	 

	 	 
	 	 
	Exhibit

Exhibit

	 	I-C

II-E
	 	Third Revised maximum Enrollment Levels (1 Page)

Fifth Revised Capitation Rates (1 Page)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Amendment No. 5, Page 2 of 2

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

EXHIBIT I-C

THIRD REVISED ENROLLMENT LEVELS

Table 1

	 	 	 	 	 	 	 	 	 
	County:	 	 	 	 	 	Maximum Enrollment Level
	Brevard
	 	 	8,000	 	 	 	 	 
	Broward
	 	 	 	 	 	 	14,000	 
	Miami-Dade
	 	 	25,000	 	 	 	 	 
	Hernando
	 	 	8,000	 	 	 	 	 
	Hillsborough
	 	 	40,000	 	 	 	 	 
	Lake
	 	 	8,000	 	 	 	 	 
	Lee
	 	 	18,000	 	 	 	 	 
	Manatee
	 	 	8,000	 	 	 	 	 
	Orange
	 	 	30,000	 	 	 	 	 
	Osceola
	 	 	8,500	 	 	 	 	 
	Palm Beach
	 	 	12,000	 	 	 	 	 
	Pasco
	 	 	15,000	 	 	 	 	 
	Pinellas
	 	 	25,000	 	 	 	 	 
	Polk
	 	 	30,000	 	 	 	 	 
	Sarasota
	 	 	8,000	 	 	 	 	 
	Seminole
	 	 	8,000	 	 	 	 	 
	Volusia
	 	 	8,000	 	 	 	 	 

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

2

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

EXHIBIT II-E

FIFTH REVISED CAPITATION RATES

A. Table 2 — General Capitation Rates plus Mental Health Rates:

	 	 	 	 	 
	Area 4 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Volusia
	 	 	015005342	 

B. Table 4 — General Capitation Rates plus Mental Health Rates plus Transportation Rates:

	 	 	 	 	 
	Area 3 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Hernando
	 	 	015005350	 
	Lake
	 	 	015005341	 
	Area 5 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Pasco
	 	 	015005304	 
	Pinellas
	 	 	015005305	 
	Area 6 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Hillsborough
	 	 	015005300	 
	Polk
	 	 	015005307	 
	Manatee
	 	 	015005318	 
	Area 7 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Orange
	 	 	015005308	 
	Seminole
	 	 	015005313	 
	Osceola
	 	 	015005314	 
	Brevard
	 	 	015005336	 
	Area 8 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Lee
	 	 	015005302	 
	Sarasota
	 	 	015005306	 
	Area 9 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Palm Beach
	 	 	015005310	 
	Area 10 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Broward
	 	 	015005311	 
	Area 11 Counties:
	 	 	 	 
	County:
	 	Provider Number:
	Miami-Dade
	 	 	015005312	 

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Exhibit II-E, Page 1 of 1

3EX-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

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