Medicaid transformation is closely reviewed in Florida

This week the federal government signed off on the first part of a plan that could eventually steer more than 3 million low-income Floridians on Medicaid into a managed care, or HMO system. The decision comes two years after Florida lawmakers approved the conversion in an attempt to control costs in the $21 billion program.

At that time, retirees were skeptical of how it would work.

That skepticism has not gone away but now the federal Centers for Medicaid & Medicare Services has signed off on part of a waiver allowing Florida to begin its transition to managed care for Medicaid recipients in long-term care.

Under the state’s current fee-for-service model, when the patient goes to a nursing home, hospital or doctor, the health provider bills the state, and the state cuts a check. But that system is expensive, difficult for frail patients to navigate and doesn’t necessarily result in good care. Florida officials and industry representatives say managed care will be an improvement.

In the new Medicaid managed care model, Florida will be paying health plans in various regions of the state a set amount of money per person to treat the elderly and disabled in long-term care. The waiver affects 87,000 Medicaid recipients in long-term care. It provides $417 million in the first year to take care of 36,795 beneficiaries in home- and community- based services, according to the letter from CMS to the state health agency. These are patients who would otherwise qualify for nursing home care.

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Source – Kaiser Health News

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