Find your Medicaid documents and forms to manage your plan including:
Adobe Reader is needed to view PDFs.
Get Adobe Reader
Member materials
Do you have any questions about your plan? Check out the Member Handbook, PDF opens new window to find full details of your plan and benefits. Information on Humana Medical Plan, Humana Long-Term Care Plan and Humana Comprehensive Plan can all be found in the member handbook.
If you're looking for a doctor, you can use these directories to see a list of providers you can choose from in your area to get health services.
You can also search for doctors, pharmacies and other healthcare facilities online using our Find a doctor tool.
Region 1
Counties: Escambia, Okaloosa, Santa Rosa and Walton
Provider Directory – English and Spanish (FL counties: Bay, Escambia, Holmes, Okaloosa, Santa Rosa, Walton, and Washington; AL counties: Baldwin, Covington, Escambia, Geneva, Houston, and Mobile; GA counties: Cook, Dekalb, Glynn and Lowndes) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Escambia, Okaloosa, Santa Rosa, Walton, Bay, Holmes and Washington counties) , PDF opens new window
Region 2
Counties: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington
Provider Directory – English and Spanish (Bay, Calhoun, Dixie, Franklin, Gadsden, Gulf, Hamilton, Holmes, Jackson, Jefferson, Lafayette, Leon, Liberty, Madison, Suwanee, Taylor, Wakulla, Walton, and Washington counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Bay, Calhoun, Franklin, Gadsden, Gulf, Hamilton Holmes, Jackson, Jefferson, Leon, Lafayette, Liberty, Madison, Taylor, Wakulla, Washington, Dixie, Suwanee and Walton counties) , PDF opens new window
Preferred Drug List – English , PDF opens new window
Preferred Drug List – Spanish , PDF opens new window
Region 3
Counties: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union
Provider Directory – English and Spanish (Alachua, Bradford, Citrus, Columbia, and Dixie counties) , PDF opens new window
Provider Directory – English and Spanish (Baker, Clay, Flagler, Hillsborough, Levy, Marion, Putnam, Sumter, Suwanee, and Union counties) , PDF opens new window
Provider Directory – English and Spanish (Polk, Seminole, St. Johns, Taylor and Volusia counties) , PDF opens new window
Provider Directory – English and Spanish (Gilchrist, Hamilton, Hernando, and Lafayette counties) , PDF opens new window
Provider Directory – English and Spanish (Lake, Madison, Orange, Osceola, and Pasco counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwanee and Union counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Baker, Clay, Flagler, Hillsborough, Madison, and Orange) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Osceola, Pasco, Polk, Seminole, St. Johns, Taylor, and Volusia counties) , PDF opens new window
Region 4
Counties: Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia
Provider Directory – English and Spanish (Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties) , PDF opens new window
Provider Directory – English and Spanish (Alachua, Bradford, Brevard, Columbia, and Lake) , PDF opens new window
Provider Directory – English and Spanish (Marion, Orange, Putnam, Seminole and Union counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Alachua, Bradford, Brevard, Columbia, Lake, Marion, Orange, Putnam, Seminole and Union counties) , PDF opens new window
Region 5
Counties: Pasco and Pinellas
Provider Directory – English and Spanish (Lake, Pasco, Pinellas, Polk, and Sumter counties) , PDF opens new window
Provider Directory – English and Spanish (Citrus, Hernando, and Hillsborough counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Citrus, Hernando, Hillsborough, Lake, Pasco, Pinellas, Polk and Sumter counties) , PDF opens new window
Region 6
Counties: Hardee, Highlands, Hillsborough, Manatee and Polk
Provider Directory – English and Spanish (Hardee, Highlands, Hillsborough, and Manatee counties) , PDF opens new window
Provider Directory – English and Spanish (Charlotte, Desoto, Glades, Hernando, Lake, Okeechobee, Polk, Sarasota and Sumter counties) , PDF opens new window
Provider Directory – English and Spanish (Orange, Osceola, Pasco, and Pinellas counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Hardee, Highlands, Hillsborough, Manatee and Polk counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Charlotte, DeSoto, Glades, Hernando, Lake, Okeechobee, Orange, Osceola, Pasco, Pinellas, Sarasota and Sumter counties) , PDF opens new window
Region 7
Counties: Brevard, Orange, Osceola and Seminole
Provider Directory – English and Spanish (Brevard, Orange, Osceola and Seminole counties) , PDF opens new window
Provider Directory – English and Spanish (Highlands, Indian River, Lake, Okeechobee, Polk, St. Lucie and Volusia counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Brevard, Orange, Osceola, Seminole, Highlands, Indian River, Lake, Okeechobee, Polk, St. Lucie and Volusia counties) , PDF opens new window
Region 8
Counties: Charlotte, Collier, Desoto, Glades, Hendry, Lee and Sarasota
Provider Directory – English and Spanish (Charlotte, Collier, DeSoto, Glades, Hardee, Hendry, Highlands, Lee and Sarasota counties) , PDF opens new window
Provider Directory – English and Spanish (Hillsborough and Manatee counties) , PDF opens new window
Provider Directory – English and Spanish (Monroe county) , PDF opens new window
Provider Directory – English and Spanish (Okeechobee and Palm Beach counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Broward, Hardee, Highlands, Hillsborough, and Manatee counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Miami-Dade, Monroe, Okeechobee, and Palm Beach counties) , PDF opens new window
Region 9
Counties: Indian River, Martin, Okeechobee, Palm Beach and St. Lucie
Provider Directory – English and Spanish (Palm Beach county) , PDF opens new window
Provider Directory – English and Spanish (Brevard, Glades, Indian River, Martin, Okeechobee and St. Lucie counties) , PDF opens new window
Provider Directory – English and Spanish (Hendry, Highlands, Osceola, and Polk counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Indian River, Martin, Okeechobee, Palm Beach, St. Lucie counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Brevard, Broward, Glades, Hendry, Highlands, Osceola and Polk counties) , PDF opens new window
Region 10
Counties: Broward
Provider Directory – English and Spanish (Broward county) , PDF opens new window
Provider Directory – English and Spanish (Collier and Palm Beach counties) , PDF opens new window
Provider Directory – English and Spanish (Hendry county) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Broward county) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Hendry, Collier, Miami-Dade and Palm Beach counties) , PDF opens new window
Region 11
Counties: Miami-Dade and Monroe
Provider Directory – English and Spanish (Miami-Dade county) , PDF opens new window
Provider Directory – English and Spanish (Collier, Monroe and Palm Beach counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Miami-Dade and Monroe counties) , PDF opens new window
Long-Term Care Provider Directory – English and Spanish (Broward, Collier and Palm Beach counties) , PDF opens new window
Participant Direction Option
Find more information about another option for your long-term care plan—the Participant Direction Option (PDO). The PDO allows you to self-direct your services.
Agency for Health Care Administration (AHCA) PDO Template , opens new window
Agency for Health Care Administration (AHCA) PDO Manual , opens new window
Pharmacy resources
We know it’s important for you to understand which of your medicines are covered. Check the lists below to see which medicines your plan covers.
Preferred Drug List (English, PDF opens new window and Spanish, PDF opens new window)
Cystic Fibrosis Supplemental Drug List – English (1.15 MB) , PDF opens new window
Cystic Fibrosis Supplemental Drug List – Spanish (1.09 KB) , PDF opens new window
Recent changes to Florida Medicaid Drug List , opens new window
Over-the-counter order forms
Your pharmacy benefit lets you order certain over-the-counter (OTC) items through the mail. Use this catalog to look up OTC items you want to order each month. Fill out the form and mail, fax or phone your order to PrescribeIT Rx.
Contact us
Combined Medicaid medical and Long-term care (LTC) OTC form
Over-the-Counter Order Form—English (1.19 MB) , PDF opens new window
Over-the-Counter Order Form—Spanish (838 KB) , PDF opens new window
Prescription drug reimbursement claim form
We hope you don't have to pay for any medicine out of pocket. If it happens, let us know by filling out a reimbursement claim form, and we will try to pay you back.
Fill out the form below to send in a reimbursement claim if you paid out of pocket for a prescription.
Prescription drug reimbursement claim form (611 KB) , PDF opens new window
Legal and privacy notices
These notices provide information about how Humana uses, and when we might share, your personal information.
They also outline the various privacy rights available to you.
Individual privacy rights—English and Spanish
Rights and responsibilities—English
Rights and responsibilities—Spanish
HIPAA privacy notice—English (119 KB) , PDF opens new window
HIPAA Privacy Notice – Spanish (111 KB) , PDF opens new window
Grievance and appeals
We want you to be happy with the care you get from Humana Florida Medicaid. We hope you are getting the best care possible.
If you are not happy with any part of your healthcare plan, Customer Care, your doctor or a facility, you can send in a grievance. You can also appeal a claim or a denied service using this form.
If you are sending an appeal or grievance for another covered member, be sure to fill out an Appointment of Representative form.
Download and return the completed forms to Humana:
Contact us
Grievance/Appeal request form—English (157 KB) , PDF opens new window
Appointment of Representative form—English/Spanish (157 KB) , PDF opens new window
Your appeal rights (154 KB) , PDF opens new window
Caregiver forms
If you want your caregiver to have access to your health information, you need to fill out the protected health consent form.
You can also find the power of attorney form.
Download below and return the completed forms to:
Humana Medical Plan Customer Care
Contact us
Power of Attorney form (155 KB) , PDF opens new window
Medical
Consent for Release of Medical Information (English and Spanish) , PDF opens new window
Consent for Release of Protected Health Information (2.6 MB) English , PDF opens new window
Access Behavioral Health Consent for Release of PHI (Regions 1 & 2) PDF (195 KB) English , PDF opens new window
Beacon Consent for Release of PHI (Regions 3–11) PDF (152 KB) English , PDF opens new window
Long-term care (LTC)
LTC Consent to Share Health Facts (38 KB) English , PDF opens new window
LTC Consent to Share Health Facts (38 KB) Spanish , PDF opens new window
LTC Consent for Release of Information (965 KB) English , PDF opens new window
LTC Request for Alternative Communications (396 KB) English , PDF opens new window
Living will
Download and complete your living will, fill out an advanced directive or complete an organ donation form.
Living will (152 KB) , PDF opens new window
Advanced directive (151 KB) (Healthcare Surrogate Designation) , PDF opens new window
Organ donation form (152 KB) (Uniform Donor Form) , PDF opens new window
Performance measurement surveys
Let us know how we are doing. We want to make sure we are giving you the best care and services to manage your health. Download performance measurement reports and take our member satisfaction survey.
Guide to HEDIS® measurements , opens new window
State of Health Care Quality Report , opens new window (NCQA website)
Health Risk Assessment (HRA)
If you have a care coordinator or a case manager, they may ask you to complete the HRA originally sent in your welcome kit and listed below.
Take our health risk assessment (877 KB) English, PDF opens new window
Take our health risk assessment (872 KB) Spanish, PDF opens new window
Smartphone benefit information
Humana and SafeLink wireless will provide Medicaid medical members with a free cellphone service and smartphone to call your family, friends and doctors. Plus, you’ll get even more extra services as a member.
Download this fact sheet to learn all the details and how to sign up.
Download SafeLink mobile phone flyer [719 Kb]—English and Spanish, PDF opens new window
