TALLAHASSEE -- 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 senior citizens across the state to move into managed-care plans.
The approval, announced Monday, means that Medicaid-eligible seniors who need long-term care probably 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 move into such facilities.
Senate Appropriations Committee Chairman Joe Negron, R-Stuart, who played a key role in drawing up the Medicaid changes, said nursing homes would 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 go to nursing facilities only when necessary.
“Now, it gives us the ability with Medicaid to provide these options in the community for seniors,” Negron said.
Gov. Rick Scott and the 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 would result in managed-care plans squeezing the care provided to low-income people.
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 decision.
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. 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 the issue of 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.