Florida Health Study Guide

Florida’s health law is defined as much by what the state declined to do as by what it enacted. It never expanded Medicaid, it never built a state exchange, and it never adopted a conforming external review process — so the federal machinery fills those gaps. What Florida did write for itself is where the 2-40 exam concentrates: a two-speed prompt-pay rule, and a continuation act that covers exactly the employers federal COBRA does not.

The three things Florida did not do

Florida did not expand Medicaid under the ACA. Coverage runs through Statewide Medicaid Managed Care, administered by the Agency for Health Care Administration (AHCA), and the state’s CHIP program is Florida KidCare. Florida has no state-based exchange — individual marketplace coverage is bought on the federally-facilitated HealthCare.gov. And Florida does not run its own conforming external review, so a final adverse benefit determination goes to the federal HHS-administered process, whose independent review organization’s decision binds the plan.

Prompt pay — the medium of submission decides the deadline

Most states publish one clean-claim deadline. Florida publishes two, and the trigger is how the claim arrived. Under F.S. § 627.6131 an insurer has 20 days to pay or deny a clean electronic claim (final action within 90 days; the claim becomes uncontestable at 120) and 40 days for a clean paper claim (final action within 120 days; uncontestable at 140). Overdue clean claims carry 12% per year simple interest under § 627.6131(7). The identical deadlines apply to HMOs under § 641.3155, so an HMO fact pattern does not change the numbers.

Florida’s mini-COBRA — read the inequality carefully

Federal COBRA applies to employers with 20 or more employees. Florida’s continuation law — the Florida Health Insurance Coverage Continuation Act, F.S. § 627.6692 — covers the ones underneath that line: employers with fewer than 20 employees. The two regimes fit together rather than overlapping, and the exam tests the boundary far more often than it tests either scheme alone.

The numbers that hang off it: continuation runs up to 18 months, extending to up to 29 months in the case of disability, and the employer may charge up to 115% of the group premium — rising to 150% during the 11-month disability extension.

Long-term care and Medicare supplement — 30 days each

Both products carry a 30-day free look in Florida — long-term care under F.S. § 627.9407(8) and Medicare supplement under § 627.674(4). That is the top rung of a ladder your life material covers from the bottom: 14 days for an individual life policy, 21 for an annuity, 30 for LTC and Medicare supplement. A senior-market producer is working at the 30-day end of it almost all the time.