TALLAHASSEE -- Dealing with issues that affect the health care of millions of poor and uninsured residents, Florida leaders in 2013 could move forward with a long-awaited overhaul of the Medicaid system and likely will decide how to carry out the federal Affordable Care Act.

Both issues are highly complex and politically controversial.

Gov. Rick Scott and Republican legislative leaders want to require almost all Medicaid beneficiaries statewide to enroll in managed-care plans, an effort that has drawn opposition from Democratic lawmakers and some patient advocates. Meanwhile, after waging a legal and political battle, Scott and his GOP colleagues face the reality that the Affordable Care Act — better known as Obamacare — is here to stay.

Lawmakers in 2011 approved the Medicaid overhaul, but it requires approval from the federal government. State Medicaid director Justin Senior told lawmakers this month that he expects a decision from federal officials in February about the first part of the overhaul.

That part would lead to managed-care enrollment for seniors who need long-term care. If approved by federal officials, those changes would start taking effect by Oct. 1. Broadly, the idea is that HMOs and other types of managed-care plans could provide services that would allow seniors to stay in their homes and communities instead of having to live in costly nursing facilities.

The state Agency for Health Care Administration has been seeking approval from the federal Centers for Medicare & Medicaid Services for more than a year and also has started the contracting process for managed-care plans that want to take part in the long-term care system. The state would be split into 11 regions, with a limited number of plans receiving contracts in each region.

Senior said much of the state’s negotiations with federal officials have focused on safeguards to make sure that the program would be based on providing services in people’s homes and communities and would not be a "nursing home light" system.

The state also is seeking approval to require the broader Medicaid population, such as low-income women and children, to enroll in managed-care plans. Those changes would start to take effect by October 2014, though Senior said the state has focused first on getting approval for the long-term care portion of the overhaul.

"As we get that approval, I think our guns will turn, if you will, onto the (proposal dealing with the broader Medicaid population), and we will really start to negotiate with the federal government to get to the best possible product there as well and do it in a timely fashion,’’ Senior told the House Health & Human Services Committee.

Supporters of the overhaul contend that it will help hold down costs in the Medicaid program and better coordinate care for beneficiaries. Medicaid serves more than 3.2 million people in Florida, and is expected to spend about $20.8 billion this fiscal year.

But critics of the overhaul have long raised concerns that for-profit HMOs will scrimp on care for the beneficiaries. Rep. Elaine Schwartz, D-Hollywood, pointedly asked Senior about whether the state will have enough oversight of the managed-care organizations.

"I don’t hear from you that there is a beefing up in these programs to oversee these managed-care companies who could easily be diverting that money to the wrong purposes,’’ Schwartz said.