Government

Medicaid Managed Care Plan to Begin in August

By: Jim Saunders News Service of Florida | Posted: May 7, 2013 3:55 AM

Patient with Doctor

Credit: Shutterstock - Monkey Business Images

Two years after getting approved by lawmakers, Florida's shift to a statewide Medicaid managed-care system will start Aug. 1 for seniors who need long-term care in the Orlando area.

The state Agency for Health Care Administration held a contract-signing ceremony Monday with seven health plans that eventually will provide long-term care services to about 85,000 people across the state. That is the first part of a long-debated Medicaid transformation that also will later include the broader Medicaid population.

Such a contract-signing ceremony is unusual in state government but was an indication of the emphasis that Gov. Rick Scott's administration has placed on revamping Medicaid.

"This is a major milestone along the way to the statewide Medicaid managed-care program,'' said Justin Senior, an AHCA deputy secretary who directs Medicaid.

Federal officials in February approved the long-term care portion of the Medicaid changes, though AHCA had already gone through a lengthy process in which health plans bid for contracts in 11 regions of the state. The seven companies that received contracts in all or some of the regions were American Eldercare, Amerigroup Florida, Coventry Health Care of Florida, Humana, Molina Healthcare of Florida, Sunshine Health and United HealthCare of Florida.

Also, another plan, Little Havana Activities and Nutrition Centers of Dade County, has filed a bid protest in the state Division of Administrative Hearings. If successful, it could receive a contract in a region that includes Miami-Dade and Monroe counties.

The basic concept behind the long-term care portion of the Medicaid changes is that managed-care plans will be able to better coordinate services, which could help seniors and people with disabilities stay in their homes instead of having to move into nursing facilities. Ultimately, that could help hold down state costs in the Medicaid program, as nursing-home care is typically more expensive than home- and community-based services.

AHCA will start the changes Aug. 1 in a Central Florida region that includes Orange, Brevard, Osceola and Seminole counties. The long-term care changes will gradually expand to other areas and are expected to be in place statewide by March 2014.

Florida has long operated what is known as a "nursing home diversion" program, which is a smaller-scale version of the statewide long-term care system.

American Eldercare, for example, already provides services in the diversion program and has received contracts in all 11 regions of the new managed-care system. Robert Schemel, president of the company, said the biggest difference with the new system will be the volume of people served.

Lawmakers and Scott in 2011 approved a plan to transform Medicaid into a statewide managed-care system, despite opposition from some groups that argued HMOs could shortchange the care people receive.

The state submitted applications to the federal Centers for Medicare & Medicaid Services in August 2011. While it has received approval to move forward with the long-term care portion of the plan, it is still waiting for a final sign-off on the broader Medicaid population -- though federal officials sent a letter earlier this year indicating that such approval was near.


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