Medicaid Managed Care In Florida: Federal Waiver Approval .
OCTOBER 2013Medicaid Managed Care in Florida:Federal Waiver Approval and ImplementationFlorida’s new Medicaid plan – called the Managed MedicalFlorida’s Experience withAssistance program – will move nearly all of the state’sMedicaid beneficiaries into managed-care plans.This new plan, approved in June 2013, is the final chapterin a Medicaid reform effort that is almost a decade old.Drawing on experiences from that decade of experimentation,the new plan incorporates significant consumer protections,some unique to Florida. Most of these protections establish the need for ongoing oversight andpublic input, creating opportunities for stakeholder monitoring and comment.MEDICAIDREFORMINTRODUCTIONOn June 14, 2013, the federal Centers for Medicare &Medicaid Services (CMS) approved Florida’s request to movealmost its entire Medicaid program for acute care services intomanaged care.1 The agreement was the culmination of manyyears of negotiations between the state and federal government.The State of Florida began efforts to reform Medicaid in2005, when it received a Section 1115 Medicaid waiver fromthe federal government. That waiver enabled the state tolaunch in 2006 a five-year pilot program in Duval andBroward counties to test reform strategies. (The next year,three suburban and rural counties – Baker, Clay and Nassau –were added to the pilot.) The pilot waiver was extended,with some modifications, in 2011.Today’s Managed Medical Assistance (MMA) programessentially extends statewide the Medicaid systems thatwere in place in the five pilot counties since 2006.This move to statewide implementation of Florida’sSection 1115 Medicaid managed care waiver not onlywas lengthy, but subject to much controversy.2 Significantchanges have occurred along the way in the state’s vision forreforming its Medicaid program, and the growth of Medicaidmanaged care in Florida and nationally has continued duringthis period. Florida’s agreement contains some unusualconsumer protections, described below, that reflect theintensity of concerns about Florida’s history with managedcare. Many of the unique features of the original proposalhave been dropped. The waiver is largely now about movingto risk-based managed care.MEDICAID REFORM IN FLORIDA:KEY EVENTSOctober 2005Federal government approveswaiver allowing Medicaid pilotprograms in Florida.July 2006Pilot begins operation in Browardand Duval counties.July 2007Pilot expands to three suburbanand rural counties: Baker, Clayand Nassau.December 2011Federal government approves athree-year extension of the pilotwaiver, with modifications basedon lessons learned during thefirst five years.June 2013Federal government approvestaking the pilot program statewide,beginning in 2014.This brief analyzes the terms of the agreement underwhich Florida’s Medicaid program will operate going forward.It includes some suggestions for next steps in assuring thatFlorida’s Medicaid program operates in a way that meets theneeds of the millions of Floridians who rely on Medicaid fortheir health care, and ensures that responsible programmanagement and oversight of managed care leads tocost-effective use of taxpayer dollars.This educational brief is one of a series commissioned by the Jessie Ball duPont Fundand the Winter Park Health Foundation and authored by Joan Alker and Jack Hoadleyof the Health Policy Institute at Georgetown University.
Florida’s Experience withMEDICAIDREFORMWHY WAS A SECTION 1115MEDICAID WAIVER NEEDED?Medicaid is a federal-state partnership, and states have manyoptions under federal Medicaid rules that can be exercisedsimply by submitting state plan amendments. Section 1115waiver authority is necessary when a state wishes to makechanges to its program that eliminate or change certain federalrequirements, or spend Medicaid dollars in a different way.In Florida’s case, some of what the state wanted to do couldhave been done without a waiver, as long as the state compliedwith existing federal consumer protections for managed care.In fact, states can require large groups of Medicaid beneficiariesto enroll in capitated managed care arrangements withoutspecial permission from the federal government. Childrenwithout disabilities (the single largest group of beneficiaries),parents, and adults who have disabilities can all bemandatorily enrolled in managed care without the authorityof a federal waiver.But Florida’s scope of change was especially broad.Florida is moving most of its populations into managed care –including persons who are eligible for both Medicare andMedicaid, children who are receiving disability payments,and children in foster care arrangements, among others.The state's desire to move these more vulnerable populationsinto managed care necessitated special federal approval.Although some regions with lower penetration today arethe state’s rural areas, Miami-Dade County has only aboutone-third of its Medicaid population in managed care.The highest penetration of managed care is in the countiesthat participated in the pilot (Broward, Duval, Baker, Clay,and Nassau), where managed-care enrollment is abouttwo-thirds of the Medicaid population.4Managed-care penetration also varies by population.About two-thirds (63 percent) of TANF beneficiaries(i.e., low-income children and parents) and half(47 percent) of SSI beneficiaries (i.e. persons receivingdisability payments) are currently in managed carestatewide. By contrast, only 9 percent of those duallyeligible for Medicare and Medicaid and virtually none ofthose in highly specialized populations are in managed-careplans today. The dually eligible and other populationgroups comprise about one-fourth of the statewideMedicaid population.WHO MUST PARTICIPATE?In general, the waiver mandates managed care for mostMedicaid beneficiaries.5Beneficiaries in a few categories are not required toparticipate, but may choose to. These voluntary participantsinclude anyone with some other source of health carecoverage (other than Medicare), anyone age 65 or olderwho resides in a mental health treatment facility, anyone inan intermediate care facility for individuals with intellectualdisabilities, and individuals with development disabilitieswho are enrolled in the home and community based waiverprogram or are on the waiting list for such services.6Medicare beneficiaries who are fully eligible for bothMedicare and Medicaid will be required to participate inthe new program for their Medicaid services, but Medicarebeneficiaries who get only premium and cost-sharingassistance from Medicaid are excluded.7CURRENT MANAGED-CARE ENVIRONMENTEven before the new program goes into effect, nearlyhalf (47 percent) of Florida’s Medicaid beneficiariesare enrolled in managed-care organizations (MCOs) –an optional program introduced in 1984.3 (About one-thirdof the Medicaid beneficiaries not currently enrolled inmanaged care participate in Florida’s MediPass program –a fee-for-service, primary care case management programthat has been in place since 1991.)The extent ofMedicaid managedREGIONAL BREAKDOWN OF CURRENT MANAGED CAREcare in Florida variesconsiderably byAHCACountiesCurrent ManagedPlans AllowedRegionCarePenetrationUnder New Waivergeography. In six of1Escambia, Okaloosa, Santa Rosa, Walton28%2the 11 olmes,34%2regions used byJackson, Jefferson, Leon, Liberty, Madison,Florida's Agency forTaylor, Wakulla, Washington3Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist,36%3 to 5Health CareHamilton, Hernando, Lafayette, Lake, Levy, Marion,AdministrationPutnam, Sumter, Suwannee, Union(AHCA), home to4Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia59%3 to 5about half of the5Pasco, Pinellas50%2 to 4state’s population,6Hardee, Highlands, Hillsborough, Manatee, Polk55%4 to 77Brevard, Orange, Osceola, Seminole53%3 to 6managed-care8Charlotte, Collier, DeSoto, Glades, Hendry, Lee, Sarasota38%2 to 4penetration e42%2to 4between one-fourth10Broward66%2to4and one-half of11Miami-Dade, Monroe36%5 to 10eligible beneficiaries.2
Florida’s Experience withMEDICAIDREFORMWHAT MANAGED-CARE PLANS WILL PARTICIPATE?Implementation of the new Managed MedicalAssistance program will occur by region, based on AHCA's11 administrative regions. The state is using a competitiveprocurement process to select managed-care organizationsfor each region. Several types of managed-care organizations,such as Health Maintenance Organizations (HMOs),Provider Service Networks (PSNs), or similar organizationsare eligible to participate. Enrollees in each region willhave a choice of at least two plans.The invitation to participate was issued to managed-careorganizations in December 2012; winning bids wereannounced in September 2013. Final awards could bedelayed, however, if unsuccessful plans in any of theregions appeal the state’s decisions. From a total of 27 plansthat submitted bids in at least one region, 10 plans wereselected to serve the general Medicaid population. Theseselected plans include 6 HMOs and 4 PSNs.8 All of theseorganizations already participate in Florida Medicaid underthe current system. None of the organizations was selectedto participate in all 11 regions, but Sunshine Health Plan(operated by Centene) was selected in 9 regions.The Provider Service Networks that were selected willbe available in a subset of regions, based in part on theorganization’s provider networks. These PSNs typicallyare centered on a regional hospital system (e.g., First CoastAdvantage, operated by Shands Jacksonville MedicalCenter) or on a primary care provider network (e.g., PrestigeHealth Choice, operated by 23 community health centers).At least one PSN was selected in each region.In addition to the plans that will serve the general Medicaidpopulation, five other companies were selected to offerspecialty plans intended to serve individuals with specificconditions (e.g., HIV/AIDS or severe mental illness) or selecteligibility groups (e.g., children in the child welfare system).9Although all plans selected to serve the general Medicaidpopulation already participate in Medicaid, a substantialshare of Medicaid beneficiaries enrolled in managed caretoday are enrolled in plans that were not selected to servetheir regions. The share of beneficiaries required to select anew plan varies considerably by region. For example, inRegion 4, where Duval County and three nearby countiesare participating in the pilot program, about 90 percent ofparticipating beneficiaries in the pilot counties will be ableto stay in the same plan if they wish to do so. By contrast,in Region 10 (Broward County), about half of those inmanaged-care plans will need to select a new plan.Issues to monitor: Are PSNs prepared to operate undercapitation? How do transitions work out for those currentlyenrolled in managed-care plans not selected for the new program?How will the specialty plans operate?WHAT IS THE TIMELINE?A key feature of Florida’s agreement with the federalgovernment is the requirement that implementation bestaggered and that a readiness plan must be approved by CMSbefore individual regions can go forward with implementation.According to the waiver agreement, the state mustsubmit an implementation plan to the federal governmentby October 31, 2013. This plan must include the state’splans for conducting a “readiness review” and a solvencyassessment for participating plans. Readiness reviews mustinclude assurances that there is adequate capacity in thesystem, a means for access to care outside of plan networks,and additional attention to access to care for enrollees withspecial health care needs and cultural considerations.CHANGES AHEAD FOR POPULARPROVIDER SERVICE NETWORKSProvider ServiceNetworks havehad the option ofbeing paid usinga per-personcapitation rate ora fee-for-servicerate. Throughoutthe history of thefive-county pilot,PSNs that choseto operate on afee-for-servicebasis have not been moved to a capitated system, even thoughsuch a move was anticipated from the inception of the pilot.Every year, the transition was delayed.These PSNs in the pilot counties have been popular withenrollees – especially those with disabilities. A higher shareof people with disabilities, compared to children and families,have opted to enroll in PSNs, perhaps because of existingrelationships with the sponsoring provider systems.Going forward, AHCA reports that all PSNs bidding to remainin Medicaid will do so by accepting risk and moving out offee-for-service reimbursement.10 It is unclear how this willaffect beneficiaries, but given the high proportion of personswith disabilities and chronic health conditions that will bemoving into a fully capitated environment, this developmentwill be worth monitoring. In the past, while there have notbeen many complaints submitted as a percentage of theoverall Medicaid population, a disproportionate proportionof the complaints filed have been with HMOs as opposedto PSNs. In the year that ended June 30, 2013, HMOs had52 percent of total Medicaid enrollment but garnered 75percent of all complaints, while PSNs had 48 percent ofenrollment and 25 percent of complaints. 113
Florida’s Experience withMEDICAIDREFORMEnrollment, which will be staged across the 11 AHCAregions, will begin no earlier than January 1, 2014, and thetransition of all regions in theory will be complete byOctober 31, 2014. According to the Governor’s office,implementation might begin April 1, 2014.12 A broad-basedoutreach and education campaign is required to begin 90days before the start of enrollment in any particular region.A key factor in the timeline is a careful review both bythe state and the federal government to ensure that the stateand the plans are ready for implementation. Furthermore,as implementation phases in by region, the state must reportto the federal government on the record of implementationin each region – including stakeholder feedback and howany problems were resolved. Agreement to proceed to thenext phase is contingent on submission of all requiredreports and a plan to address any problems identified.Issues to monitor: What information is made available aboutreadiness? What stakeholder input is solicited about theimplementation record? Are “pauses” deemed necessaryby CMS after the initial rounds of implementation?HOW WILL MANAGED CARE BE OPERATED?There are substantial protections built in to Florida’swaiver intended to address many of the problems that haveemerged with managed care operating in Florida. Some ofthese are unique to Florida’s agreement and some are reflectedin other recent waiver agreements CMS has reached withstates such as Kansas, New Mexico and Oregon. Still othersmerely restate what federal law has required for many years.Key features of the agreement intended to protect consumersand improve plan performance include:MEDICAL-LOSS RATIO:A medical-loss ratio measures the percentage of premiumdollars that an insurer spends on medical care vs. administrative costs, advertising and profits. The Affordable CareAct imposed a medical-loss ratio on plans operating in theprivate insurance market, and at least 11 states have enactedmedical-loss ratios on some or all of their Medicaid dollars.13However, federal law does not generally require a medicalloss ratio for Medicaid insurers and they are not subject tothe new ACA requirements.CMS included a medical-loss ratio requirement of 85percent in Florida’s December 2011 agreement extendingthe five counties' pilot programs, and the recent waiveragreement extends this statewide. This appears to be thefirst time that CMS has required a medical-loss ratio as partof a Section 1115 Medicaid waiver agreement.All plans providing acute care services (not long-term careservices) will need to spend 85 percent of premium revenueson medical care and report quarterly on their medical-lossratios. CMS will determine what corrective action will betaken if plans do not meet their ratios. This will be animportant issue for ongoing monitoring.While medical-loss ratios are not intended to be a proxyfor plan performance, they do provide an important floorfor how much a plan actually spends on meeting the healthneeds of its enrollees. A national study (which includedMedicaid HMOs in Florida) found that insurers who werepublicly traded spent more money on administrative costs,had lower medical-loss ratios and performed worse onclinical quality measures.14 The clinical quality measuresexamined included preventive care, treatment of chronicconditions and consumer satisfaction. Publicly traded plansare the dominant carriers in Florida’s Medicaid program.Issues to monitor: Which plans have higher medical-loss ratiosand are spending more on patient care? How is the ratio beingcalculated – what counts as a medical expense? Are plans withhigher medical-loss ratios performing better on quality measures?COMPREHENSIVE QUALITY STRATEGY,PLAN REPORTING MEASURES:The special terms and conditions accompanying the Floridawaiver include a set of requirements on quality of care. Akey component is that the state must adopt and implementa comprehensive state quality strategy that focuses onquality improvement at state, plan and provider levels.The state is expected to adopt a set of quality metrics forthis purpose and to set targets on the metrics that equal orexceed the 75th percentile national Medicaid performancelevel. In addition, these metrics would be used to establishplan performance improvement projects focusing on areassuch as improved prenatal care and well-child visits in thefirst 15 months and better preventive dental care for children.The state is also required to create consumer healthplan report cards to be available to consumers and otherstakeholders on an annual basis – a feature unique toFlorida’s waiver.Issues to monitor: What quality metrics are selected?What information does the state provide on quality metrics?When are consumer health plan report cards made available?Are the report cards reasonably transparent and easy forconsumers to understand? Are report card ratings used bybeneficiaries? Are appropriate actions taken by the state ifplans fail to meet quality targets?4
Florida’s Experience withMEDICAIDREFORMNETWORK ADEQUACY:Concern about an inadequate number of physiciansand other providers for Medicaid beneficiaries has been anongoing issue in Florida. In our analysis of the pilot program,we identified provider participation as an ongoing concernand presented evidence that provider participation haddeclined in counties where the pilots were located.15 Wefound that there was a net decline in the pool of physiciansserving Medicaid patients in Duval and Broward countiesand that participating providers were seeing fewer patients.In the new program, the competitive procurementinvitations to plans included a number of requirementsaround network adequacy, consistent with the special termsand conditions in the federal waiver. These include policieson network capacity, travel time and distance standards,and availability of appointments. In addition, plans areexpected to have networks with the capacity to serve asubstantial share of the region’s Medicaid population,and the state intends to validate provider network listingson a regular basis. The state must report on its policies toCMS by 90 days after the waiver approval.Issues to monitor: Are providers who have traditionally servedMedicaid beneficiaries satisfied with their ability to be included inplan networks? Is there any decrease in the overall number ofproviders treating Medicaid beneficiaries? Are beneficiaries havingdifficulty in accessing primary care providers or specialists? Is thestate making information available (for example, analysis of planencounter data) to demonstrate access? Are “secret shopper”studies being conducted to see if providers really are acceptingnew Medicaid patients?MEASURES TO ENSURE PLAN STABILITY:In the five-county pilot program, 11 of the 14 HMOsthat participated in the first year of the pilot later withdrew(by contrast, only one of the participating eight PSNswithdrew). Representing well over half of all programenrollees in these counties, these withdrawals have resultedin significant disruptions for Medicaid beneficiaries. Aninvoluntary change of plans, at minimum, means dealingwith a different plan and can lead to changes in health careproviders and coverage of prescription drugs.Under the terms of the new program, provisions havebeen added with the goal of increasing program stability.The procurement for plan participation under the newwaiver requires a five-year commitment to the program.Plans that leave a region before the end of a contract termwill face penalties and will be required to pay AHCA forthe cost of various transition activities. In addition, a planthat elects to withdraw from one region must terminate itsparticipation in all other regions. The rules also establish amaximum number of plans per region, based on population,with the intent of ensuring adequate enrollment for allparticipating plans.Issues to monitor: What is the distribution of enrollment acrossparticipating plans? Are there any threats to withdraw duringthe program’s first year? Are the new requirements effectivedeterrents to plans to withdraw?ENROLLMENT PROCEDURES:As the rollout occurs in each region, eligible beneficiarieswill receive a letter with enrollment information. They willhave 30 days to select a plan and another 90 days afterenrollment to change that selection. Choice counselingresources are available as in the past. Those beneficiarieswho do not select a plan will be enrolled automatically intoa plan – a common practice known as “auto-enrollment.”The program will take into account both individualcircumstances and plan capacity in making auto-enrollments.Those in a managed-care organization under the current systemwill be assigned to that plan, if possible. For those in fee-forservice Medicaid or MediPass, the state must use its data tomatch the individual to a plan where the network includes theperson’s primary care provider. Where no record of a providerexists, the state should determine whether a plan’s primarycare providers are geographically accessible for the beneficiary.Auto-enrollments also should ensure that family membersare placed together in the same plan to the extent possible.For beneficiaries who already are participating in the managedlong-term care program, the intention is to assign them toplans offered by the same company to the extent possible.Issues to monitor: Do beneficiaries generally understand the planchoices? How many beneficiaries make voluntary plan selections,and how many are auto-enrolled? Do counts of voluntaryselections include those rolled over from plans under the currentsystem? For those who are auto-enrolled, are they accuratelyassigned to plans where their providers are in the network?Are family members placed in the same plan?THE ENHANCED BENEFITS PROGRAMA unique feature of Florida’s Medicaid changes sinceinception has been the Enhanced Benefits Program, intendedto encourage Medicaid beneficiaries to engage in “healthybehaviors,” such as obtaining preventive care, participating insmoking cessation programs, etc. Credits earned through thisprogram are redeemable by participants at local drug storesfor approved products. A waiver has been needed to spendfederal Medicaid dollars in this way.The program was slow to get off the ground with highadministrative costs. (Alker and Hoadley, Briefing #6, July 2008)While popular with beneficiaries, there is little evidence thatit has been altering their behavior.The new agreement terminates the current program startingon July 1, 2014 and instead requires plans to develop their ownincentive programs.5
Florida’s Experience withMEDICAIDREFORMOPPORTUNITIES FOR PUBLIC INPUT:Another unique feature of Florida’s waiver agreementis the creation of some new opportunities for publicand beneficiary input, referred to as “stakeholderengagement processes.”Every state is required as part of its Medicaid programto have a Medical Care Advisory Committee or MCAC.As part of the waiver agreement, Florida’s MCAC musthave a minimum of four beneficiaries – positions thatmust be filled at all times unless CMS grants an exception.And the state must also convene smaller advisorycommittees that meet at least quarterly to focus onsubpopulations, including at a minimum: persons withHIV/AIDS, children with a special focus on those infoster care and the provision of dental care to allchildren, and persons receiving behavioral healthor substance use disorder services.16While additional opportunities for consumer inputare valuable, it is often difficult for beneficiaries and theiradvocates to participate in discussions in a meaningfulway if the information presented is highly technical,there is a lack of transparency, or both. Often technicalassistance and support is needed to ensure thatbeneficiaries are able to provide meaningful inputand are even able to participate.Issues to monitor: Are issues presented to the advisorycommittees in a way that facilitates meaningful input?Do concerns expressed by beneficiaries and their advocatesresult in meaningful actions to address them?CONCLUSIONFlorida’s move to risk-based managed care isfar-reaching and will require careful monitoringgoing forward. In each section of the brief, we havehighlighted issues that will be important to monitor.While the agreement reached with CMS providesmultiple pathways to monitor, regulate and overseethe performance of the managed-care plans, itremains to be seen whether these pathways willprovide meaningful opportunities for feedback andimprovement of plan performance. With both federaland state employees stretched thin with multipledemands, oversight and enforcement may be limited.Education about what protections consumers have isessential to ensure that consumers are aware of themand that they are enforced.There are reasons to be concerned as commercialrisk-based insurers expand their reach into vulnerablepopulations in Florida’s Medicaid program. Becausethese populations have higher health care needs,they tend to be more expensive and thus are sometimestargets for cost-cutting. Although managed carecarries the potential to coordinate the many careneeds experienced by vulnerable populations andthus improve that care, the need for commercialmanaged-care plans to control costs and generateprofits for shareholders may come into conflict withthe cost of providing high-quality care.Florida’s stakeholders will need to keep a carefuleye on how the myriad issues identified in this briefunfold as implementation moves statewide.6
ENDNOTES(1) Separate legal authority to move Medicaid long-term care services intomanaged care was granted by the federal government February 1, 2013,through another Medicaid authority – Sections 1915(b) and 1915(c) ofthe Social Security Act. A forthcoming brief will address this program,in which the initial enrollments began in August 2013.(2) Previous work in this series of issue briefs, as well as a prior series by JoanAlker for the Winter Park Health Foundation on the original waiverproposal in 2004 and an evaluation of the pilot county programs by JoanAlker and Jack Hoadley for the Jessie Ball duPontFund are all available pontfund.org/catgories/reports/, policy-briefs/.(3) AHCA, Florida Medicaid Managed Care and Medicaid Pilot EnrollmentReports, August 2013.(4) Ibid.(5) Medically needy beneficiaries will be required to participate in managedcare under the waiver, although there is a separate waiver request pendingthat could change the coverage for this population prior to the start ofthe new program.(6) A few groups are entirely excluded: Those eligible only for emergencyservices based on immigration status, participants in the family planningwaiver program, those eligible as women with breast or cervical cancer, andchildren receiving services in a prescribed pediatric extended care facility.(7) The excluded groups are Qualified Medicare Beneficiaries (QMBs),Specified Low-Income Medicare Beneficiaries (SLMBs), andQualifying Individuals (QIs).(8) The HMOs with winning bids are: Amerigroup Florida (2 regions),Humana Medical Plan (5 regions), Preferred Medical Plan (1 region),Sunshine State Health Plan (9 regions), United Healthcare of Florida(2 regions), and Wellcare of Florida (7 regions). PSNs with winning bidsare: Better Health (3 regions), First Coast Advantage (1 region),Integral Health Plan (2 regions), and Prestige Health Choice (7 regions).(9) The organizations with winning bids for specialty plans are: AIDSHealthcare Foundation (HIV/AIDS population in 2 regions), FloridaMHS, operated by Magellan (people with severe mental illness in 8regions), Freedom Health (4 separate plans in 8 regions, serving peoplewith cardiovascular disease, chronic obstructive pulmonary disease,7
, chronic obstructive pulmonary disease,congestive heart failure, and diabetes), Simply Healthcare Plans(HIV/AIDS population in 10 regions), Sunshine State Health Plan(child welfare population in 11 regions).(10) Telephone Interview with AHCA Director Justin Senior, August 29, 2013.(11) A total of 2990 complaints were filed during the period examined.Georgetown University HPI analysis of complaint and enrollmentdata from the four most recent AHCA Quarterly reports available athttp://www.fdhc.state.fl.us/medicaid/medicaid reform/quarterly.shtml(12) Office of the Governor, “Gov. Rick Scott Announces Florida ReceivesFinal Waiver Approval for Managed Medical Assistance Program,”June 14, for-managed-medical-assistance-program/(13) Gifford, K et al. A Profile of Medicaid Managed Care Programs in 2010:Findings from a 5
This move to statewide implementation of Florida’s Section 1115 Medicaid managed care waiver not only was lengthy, but subject to much controversy.2 Significant changes have occurred along the way in the state’s vision for reforming its Medicaid program, and the growth of Medicaid managed care in
Managed Care 101 Medicaid, Managed Care, and Children More than 70% of Medicaid beneficiaries are enrolled in private managed care organizations (MCOs) Almost 9 of every 10 children enrolled in Medicaid and CHIP receive health care through a managed care arrangement 39 states rely on MCOs to cover all or some of their Medicaid
Florida’s proposal to provide Medicaid long-term services and supports (LTSS) through managed care. As is generally the case in Medicaid managed care, Florida’s move to managed care is being promoted by the state as a way to provide care in a more coordinated fashion, but in practice may limit access to care
program, Statewide Medicaid Managed Care (SMMC) (Part IV of Chapter 409, Florida Statutes). Statewide Medicaid Managed Care has two program components: Long Term Care Managed Care Program oImplementation begins 7/1/12 with release of ITN oCertain recipients will be required to e
population is served by managed care. Per RCW 74.09.522, "The Legislature finds that competition in the managed health care marketplace is enhanced, in the long term, by the existence of a large number of managed health care system options for Medicaid clients. In a managed care delivery system, whose goal is to focus on prevention, primary
Florida Medicaid Florida Medicaid provides access to health care for low-income families and individuals and also assists aged and disabled people with the costs of nursing facility care and other medical expenses. Most Florida Medicaid recipients are enrolled in one or both of the components of the
majority of individuals receive most health care services from Florida Medicaid. Statewide Medicaid Managed Care program Managed Medical Assistance program (Implemented May 2014 –August 2014) Approximately 2.6 million enrollees in 20 plans Long‐term
2 Federal Medicaid managed care regulations12 released in April 2016 further emphasize the importance of access to care for all Medicaid populations, especially children and youth with special needs. Upon taking office, the Trump administration indicated that it will be reviewing the Medicaid managed care regulations, while states are moving forward with
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