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Florida Medicaid Managed Care Gets Final Approval
June 15, 2013
The federal government gave final approval Friday to Florida’s long-debated proposal to overhaul the Medicaid system by requiring beneficiaries statewide to enroll in HMOs and other types of managed-care plans.
The decision was not a surprise: Federal officials signaled earlier this year that they would grant approval. Also, the Obama administration had already signed off on requiring managed care for tens of thousands of Florida seniors who need Medicaid-funded long-term care.
But Friday’s announcement was a victory for Gov. Rick Scott and Republican lawmakers who approved the proposal to move to statewide Medicaid managed care in 2011, amid controversy about whether the changes would best serve the needs of low-income Floridians.
Scott this year lobbied U.S. Department of Health and Human Services Secretary Kathleen Sebelius for approval and said the managed-care changes will lead to improved coordination of care for beneficiaries. Republicans also have argued that the changes will help control rising Medicaid costs.
The approval of what is known as a Medicaid “waiver” came in a letter from the federal Centers for Medicare & Medicaid Services, which is part of Sebelius’ department.
擢lorida is leading the nation in improving cost, quality and access in the Medicaid program,” Scott said in a prepared statement. “CMS痴 final approval of our Medicaid managed care waiver is a huge win for Florida families because it will improve the coordination of care throughout the Medicaid system. Health-care providers can now more effectively manage chronic conditions and work with families to provide preventative treatments.”
Florida CHAIN, a patient-advocacy group that has been among the most-vocal critics of the managed-care requirement, issued a news release that said the federal government had included safeguards that will help protect beneficiaries. Among those safeguards: HMOs will have to spend at least 85 percent of the money they receive on patient care, a concept known in the insurance industry as a “medical loss ratio.”
But Florida CHAIN also said patients and advocates will have to remain “vigilant” and pointed, in part, to controversies about a Medicaid managed-care pilot program that began in 2006 and 2007 in Broward, Duval, Clay, Baker and Nassau counties.
泥espite these federal safeguards, the focus now shifts to the state and its efforts to implement this program that will affect access to care for millions of patients in all 67 counties,” Florida CHAIN’s statement said. “The countless reports of disrupted, delayed and denied care streaming in from the original five counties are still very fresh in the minds of all stakeholders.”
The state Agency for Health Care Administration said the plan approved Friday ultimately could affect 2.9 million people, with enrollment in managed-care plans tentatively scheduled to start in April 2014. The related move to enroll seniors in managed-care plans is slated to start this August in central Florida.
In the approval letter, federal officials also signed off on the continuation of a $1-billion-a-year program that helps hospitals and other providers care for uninsured and low-income people. That program, known as the Low Income Pool, is closely watched by the state’s hospital industry.
Along with people in the five pilot counties, hundreds of thousands of Medicaid beneficiaries already get care through HMOs. But others are part of a health-care payment system known as “fee for service” that critics have long derided as fragmented.
Scott and Republican lawmakers in 2011 approved making managed-care enrollment mandatory for almost all beneficiaries statewide and set up a process that involves HMOs and other types of plans, known as provider-service networks, competing for contracts in 11 different regions. The state needed federal approval before it could move forward with the changes, and the process crept slowly as AHCA and Obama administration officials negotiated details.
Even though final approval did not come until Friday, AHCA has already started the process of selecting managed-care plans to serve the 2.9 million people. It is expected to award contracts in September and has received proposals from about 20 managed-care plans, including major industry players such as Coventry Health Care of Florida, Humana Medical Plan, WellCare of Florida, Sunshine State Health Plan and UnitedHealthcare of Florida.
By Jim Saunders, The News Service of Florida
Comments
6 Responses to “Florida Medicaid Managed Care Gets Final Approval”
CONCERNING:
“He applied for medicaid (his income is less than $800 a month…..but got DENIED!!!! ”
Was he denied because of personal property restrictions?
I know of one who did qualify and was told that if he even owned a vehicle, he would not have qualified.
Share of cost is a joke. You have to prove to bill tracking that your accumulative cost for services rendered was more than your share of cost in order for Medicaid to kick in a pay for anything. The share of cost is an accumulative amount; however, once met, your Medicaid eligibility is only active from that point through the end of the month. It does NOT go back to the first of the month. There are some families with Medically Needy (aka Share of Cost) that desperately need the full coverage with the Medicaid program, but their share of cost is $2,000 EACH person. It’s all based on income, as it should be, but it also should be based on your medical/health issues.
Managed care has it’s ups and downs, but hopefully recipients will be assigned to ONE managed care company where they’ll stay instead of being flipped flopped from one to another month-to-month. The company managing the claims for patients and provider won the third party contract by taking a lesser ‘cut’ and agreed to be paid less than the next guy. That simply put means that customer service will be just as bad as it has always been and we won’t get state side representatives who speak clear English.
I wouldn’t say for him to make less $ but you did good for telling them about share of cost, I had forgot about that.
@susan If you are in Escambia fl you should try the Escambia community clinics Some people put them down and yes it can be a little over whelming best to go early in the am or call ahead they also have a web site they can do a sliding scale its best to go to the one downtown they will help if they can I think they like to help when they can. Maybe he can apply fr disability I don’t know all his stuff but its worth a try and is he living with you? do you claim him on your taxes? Please don’t answer on here that’s some quisstions they will ask and also maybe he should make less money so he can get Medicaid one last thing if he has a share cost this is somthin a lot of people get stuck on its ok your meds should always cost more than your share cost so you will me covered on Medicaid look people can say what they want but our government helps other countries all the time we have starving children here and that goes without meds and really when can us children get help with their smile drs go to other countries and help them poor kids here cant even get straight teeth.
Susan, unless your husband is ill of some sorts that he can’t under no circumstances work, surely ya’ll could have found a job whether it’s flipping burgers or whatever until he could get back to what he was doing previously, if not relocate by the help of family & friends. I am sympathetic about your son being a diabetic, but if he is 19 as a mother we can help but its up to them, he is grown, I also have family members that are diabetics. There is some things they have to do without just to buy the meds. & test strips. One of them used to get their strips free thru ins. but that changed & they had to start buying them & they can get pretty pricey, so that was another bill they got, once seen a man with no legs working @ a Walmart, some people are just choosy when it comes to working. Just saying I wish I could help. maybe he can start putting money back until they stop, it might not go far but it’ll help, maybe get help in other needs & save that money for his insulin. I do know what your going thru. Maybe he can make his appts around other people that you know in same vicinity that he could ride with them & save on gas & have that lil bit extra or split gas & it would save for all involved.
can you just tell me in plain straightforward simple english does that mean my 19 year old son who is a student and previously had medicaid can get it back again?
He has diabetes type 1 and no one accepts him anywhere for health insurance…soon he will have to beg on the street or die on the street for his insulin…of course i would sell my house before i would let that happen.
He has only been saved now with the alachua county choices program (not insurance but covers his prescription and doctors visits) until that program will be NO MORE due to no funding after december 2013 what are we suppose to do? He applied for medicaid (his income is less than $800 a month…..but got DENIED!!!! How can he afford to pay $500/month for his insulin? and my husband lost his job 4 years ago. We barely scrape by and have no insurance either…just the Choices program till december 2013