Medicaid Coverage

Medicaid Coverage for Children With Epilepsy in Florida

Florida Medicaid is the primary funding source for nearly every service a child with epilepsy needs, including Prescribed Pediatric Extended Care, anti-seizure medication, physician visits, therapy, and non-emergency medical transportation. Understanding how the system works removes friction for families and accelerates admission.

What Florida Medicaid Covers for Children With Epilepsy

Children enrolled in Florida Medicaid — through Statewide Medicaid Managed Care (SMMC), Children's Medical Services (CMS Health Plan), or Title XXI Florida KidCare MediKids — typically have coverage for all medically necessary epilepsy care: PPEC, neurology specialist visits, EEG and MRI, anti-seizure medications (including newer agents such as cannabidiol, cenobamate, and fenfluramine where physician-justified), genetic testing, physical/occupational/speech therapy, durable medical equipment (including pulse oximeters and seizure detection devices when ordered), and non-emergency medical transportation to all of the above.

PPEC-Specific Coverage and Prior Authorization

PPEC is a Medicaid State Plan benefit in Florida. Coverage requires a physician order documenting medical necessity, periodic recertification, and prior authorization from the child's managed care plan. Blessed Pediatric Care manages the prior authorization process end to end — submitting clinical documentation, responding to plan questions, tracking renewals, and appealing adverse determinations when warranted.

Verifying Your Child's Coverage

Our intake team verifies your child's Medicaid eligibility, how PPEC and any separately billed therapy services are covered, and any required authorization before enrollment. Contact us to confirm your current coverage.

Family Out-of-Pocket Cost

There is no co-pay or family out-of-pocket cost for PPEC under Florida Medicaid. Anti-seizure medications, therapy, transportation, and DME are likewise covered when prescribed.

Blessed Pediatric Care serves families across Miami-Dade and Broward County from our Miami Gardens facility at 4715 NW 157th St, including Miami, Hialeah, Opa-Locka, North Miami, Miami Lakes, Aventura, Doral, Hollywood, Hallandale Beach, Pembroke Pines and Miramar.

Therapy

On-Site Pediatric Therapy

Physician-ordered Physical, Occupational, and Speech-Language therapy delivered as part of the daily plan of care — coordinated with each child's neurology team.

Physical Therapy

Gross motor strengthening, gait training, postural control, and safe mobility for children with epilepsy and movement comorbidities.

Occupational Therapy

Fine motor, sensory regulation, ADL skills, and adaptive strategies — important after medication changes that affect coordination or cognition.

Speech-Language Pathology

Receptive and expressive language, oral-motor and feeding therapy for children with seizure-related developmental and dysphagia concerns.

See the full pediatric therapy program.

Admission Process

How to Enroll Your Child

Most epilepsy admissions are completed within 5 to 10 business days from the first inquiry.

1. Inquiry & eligibility
Call (305) 260-6621 or use the contact form. Our intake team verifies Medicaid coverage and the child's managed care plan.
2. Physician order & records
We collect the PPEC prescription, most recent History & Physical, current medication list, and signed seizure action plan from the treating physician.
3. Prior authorization
We submit clinical documentation to the managed care plan and track approval — no family paperwork required.
4. Facility tour & intake
Parents visit the facility, meet the nursing and therapy team, and complete intake paperwork.
5. Plan of care
The Director of Nursing builds an individualized plan of care matching every physician order and seizure action plan parameter.
6. First day & transportation
Daily Medicaid-funded transportation is scheduled, and your child begins attending. Family receives a daily summary.

Physician Referrals

For Neurologists, Pediatricians, and Hospital Case Managers

Refer in minutes — our intake team handles eligibility, prior authorization, and managed care coordination.

What to send

Signed PPEC prescription / order
Most recent History & Physical
Current medication list
Signed seizure action plan
Medicaid card / insurance information

How to send it

Call our intake team at (305) 260-6621 or email blessedpediatriccare@gmail.com. Confirmation within one business day; family contact same day.

Parent Education

Supporting Families of Children With Seizures

A confident family is a safer family. Education is part of our standard of care.

Seizure recognition

Identifying focal, generalized, absence, and myoclonic seizures — and what to document.

Rescue medication training

Hands-on instruction in intranasal midazolam and rectal diazepam administration for home.

Medication adherence

Strategies for consistent dosing, refill timing, and managing missed doses safely.

Trigger management

Sleep, hydration, illness, and screen exposure — practical guidance personalized to your child.

School coordination

Working with Miami-Dade and Broward County Schools on 504 plans, IEPs, and Hospital/Homebound.

Emergency planning

When to call 911, when to give rescue medication, and what to bring to the emergency room.

See our parent resources and education programming.

Transportation

Daily Medicaid-Funded Transportation

Reliable round-trip rides for children authorized for PPEC across Miami-Dade and Broward.

Medicaid-covered non-emergency medical transportation is typically available for every authorized child. Daily routes serve Miami Gardens, North Miami, Opa-Locka, Hialeah, Miami Lakes, Aventura, North Miami Beach, Doral, Hollywood, Hallandale Beach, Pembroke Pines and Miramar.

Higher-acuity children — including those with active seizure disorders, oxygen dependence, or tracheostomies — may qualify for ambulance or stretcher transport. Our intake team coordinates with each managed care plan's transportation broker so service is in place before the first day of attendance.

FAQ

Medicaid Coverage: Frequently Asked Questions

PPEC is a Medicaid State Plan benefit. Children with only commercial coverage typically need Medicaid as a secondary payer (often available through Children's Medical Services or SSI-linked Medicaid) to enroll. Our intake team can review eligibility pathways.

Yes. Non-emergency medical transportation is a Medicaid benefit; our team helps schedule rides through the managed care plan's transportation broker.

Denials are uncommon for children with documented epilepsy. When they occur, we file a clinical appeal with the treating neurologist's support — most are overturned.

Yes, but typically not for overlapping hours. Most families use PPEC during weekdays and private duty for evenings, overnights, or weekends.

Epilepsy & Seizure Resource Center

PPEC for Epilepsy PPEC for Seizure Disorders Skilled Nursing Physician Referral Guide Medicaid Transportation Epilepsy Condition Page Seizure Disorders Condition Page

Talk With Our Epilepsy Intake Team

Same-day response. We coordinate physician orders, prior authorization, and transportation so your child can start safely and quickly.