Feb. 5, 2013 - Federal health
officials have approved a key part of Florida's effort to transform its
Medicaid program, clearing the way for tens of thousands of seniors
across the state to move into managed-care plans.
The approval, announced Monday,
means that Medicaid-eligible seniors who need long-term care likely will
start enrolling later this year in HMOs and another type of health plan
known as a "provider service network." The long-term care changes are
the first phase of a controversial proposal to shift Medicaid
beneficiaries statewide into managed care.
A basic concept of the long-term
care changes is that managed-care plans would provide services to
seniors at home or in their communities, if possible. In doing so, many
seniors would be able to stay out of nursing homes, or at least postpone
the need to go into such facilities.
Senate Appropriations Chairman Joe
Negron, a Stuart Republican who played a key role in drawing up the
Medicaid changes, said nursing homes will continue to play an important
role in the Medicaid system. But he said seniors want to be able to "age
in place" in their homes and communities and only go to nursing
facilities when necessary.
"Now, it gives us the ability with
Medicaid to provide these options in the community for seniors,'' Negron
The senior-advocacy group AARP
Florida vowed Monday to be "watchdogs" as the new system is put in
"Florida elected officials have
said they are pushing this reform effort forward because they want to
assure the highest quality of care for frail and vulnerable Floridians
under Medicaid,'' AARP Florida State Director Jeff Johnson said in a
prepared statement. "AARP Florida will hold them to their word."
Gov. Rick Scott and the
Republican-controlled Legislature approved wide-ranging bills in 2011
aimed at shifting to a statewide managed-care system in Medicaid. The
plan was to make the changes in two phases --- first for seniors who
need long-term care and then for the broader Medicaid population.
While many Medicaid beneficiaries
already enroll in managed-care plans, backers of a statewide system
argue it would help hold down Medicaid costs and better coordinate
services for beneficiaries. But critics have long argued that the shift
will result in managed-care plans squeezing care provided to low-income
Such Medicaid proposals require
approval by the federal Centers for Medicare & Medicaid Services before
they can take effect. The federal government faced a Thursday deadline
for ruling on the long-term care proposal, after Florida gave notice
late last year that it wanted to start a 90-day "clock" to compel a
No such deadline exists for the
changes affecting the broader Medicaid population, and it remains
unclear when federal officials will make a decision. State Medicaid
director Justin Senior told lawmakers in December that the Agency for
Health Care Administration had focused first on getting approval for the
long-term care portion of the changes.
Scott sent a letter Monday to U.S.
Department of Health and Human Services Secretary Kathleen Sebelius
expressing appreciation for approval of what is known as a Medicaid
"waiver" for the long-term care changes. But he also pressed to get
approval for the shift affecting the broader Medicaid population.
"Now, our most urgent need is the
immediate approval of our second pending waiver, which relates to the
statewide Medicaid managed-care program,'' Scott wrote. "This second
waiver will give us additional flexibility within the current Medicaid
program, and it supports our goal of improving the cost, quality and
access to health care for all Florida families."
Scott met last month with Sebelius
and has appeared to try to connect the state's managed-care proposals
with a separate issue about whether Florida will expand Medicaid
eligibility under the federal Affordable Care Act. The federal
government wants states to expand eligibility as a way to provide health
coverage for more people.
But Greg Mellowe, policy director
for the patient-advocacy group Florida CHAIN, said it will be harder for
the state to get approval of the broader managed-care proposal. That
proposal would build off a highly controversial Medicaid managed-care
pilot program that operates in five counties.
"The fact that the managed
long-term care waiver was approved in no way indicates that approval of
the broader statewide Medicaid managed-care waiver can be justified or
will be forthcoming,'' Mellowe, whose group has been highly critical of
the managed-care proposal, wrote in an email.
The state Agency for Health Care
Administration has already gone through a lengthy contracting process to
choose health plans that would provide long-term care services to
seniors. That process involved competitive bidding in 11 regions of the
state and led to AHCA awarding contracts to American Eldercare, Sunshine
State Health Plan, United HealthCare of Florida, Coventry Health Care of
Florida and Amerigroup Florida.
AHCA hopes to start using the new
long-term care system as early as August in the Orlando area and
gradually move into other areas of the state. But enrollment could be
delayed in three regions - the western Panhandle, the Big Bend and Palm
Beach County and the Treasure Coast - because of protests by
The Centers for Medicare & Medicaid
Services sent a letter to the state Friday, approving the long-term care
changes effective July 1. The approval is for three years, expiring June
30, 2016, with the state able to request renewals "by providing evidence
and documentation of satisfactory performance and oversight."
Michael Garner, president of the
Florida Association of Health Plans, said moving to the long-term care
system will require an extensive education effort for seniors and family
members who will choose between managed-care plans. Like Negron, Garner
said nursing homes will continue to play an important role, but he said
he hopes the new system will help get people into the "lowest-cost
settings that are preferable for them and their families."
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