The decision was not a surprise: Federal officials signaled earlier this year that they would grant approval. Also, the Obama administration had already signed off on requiring managed care for tens of thousands of Florida seniors who need Medicaid-funded long-term care.
“Florida is leading the nation in improving cost, quality and access in the Medicaid program,'' Scott said in a statement. "CMS’s final approval of our Medicaid managed care waiver is a huge win for Florida families because it will improve the coordination of care throughout the Medicaid system. Health-care providers can now more effectively manage chronic conditions and work with families to provide preventative treatments."
Florida CHAIN, a patient-advocacy group that has been among the most-vocal critics of the managed-care requirement, issued a news release that said the federal government had included safeguards that will help protect beneficiaries. Among those safeguards: HMOs will have to spend at least 85 percent of the money they receive on patient care, a concept known in the insurance industry as a "medical loss ratio."
But Florida CHAIN also said patients and advocates will have to remain "vigilant" and pointed, in part, to controversies about a Medicaid managed-care pilot program that began in 2006 and 2007 in Broward, Duval, Clay, Baker and Nassau counties.
“Despite these federal safeguards, the focus now shifts to the state and its efforts to implement this program that will affect access to care for millions of patients in all 67 counties,'' Florida CHAIN's statement said. "The countless reports of disrupted, delayed and denied care streaming in from the original five counties are still very fresh in the minds of all stakeholders."