That experiment got off to a rocky start. Some insurers dropped out because they couldn’t earn profits. Medicaid beneficiaries complained of denied medical services, and physicians were unhappy about delayed payments and red tape. There was also minimal data on quality of care.
Still, a University of Florida review paid for by the state showed the pilot managed-care program saved taxpayer money, better coordination of care and access to specialists.
Since then, federal officials who approved Florida’s changes to Medicaid long-term and medical care instituted distinct consumer protections for the two managed-care programs.
Included in Florida’s contract with federal regulators who approved the change is a requirement that health plans spend at least 85 percent of premiums on healthcare, and only 15 percent on administrative costs and profits.
That’s not the case for the long-term care population, though Florida has agreed to report performance information to the federal Centers for Medicare and Medicaid Services on a quarterly basis during the first two years of the managed care program.
Monitoring will be done by the state’s Department of Elder Affairs, and each Medicaid long-term managed care recipient will be assigned a case manager if they don’t already have one, said Beth Kidder, assistant deputy secretary for Medicaid operations for the Agency for Health Care Administration, which manages the state’s program.
Though case managers will be employed by the health plans, Kidder said they will look out for the best interests of Medicaid recipients.
“That case manager is their advocate, their go-between, the one who makes sure they’re getting their services and are satisfied with their services,’’ Kidder said.
One of the primary goals of the long-term managed care program is to transition Medicaid recipients out of nursing homes, where the cost of care balloons because of round-the-clock medical staffing, room and board.
But if a Medicaid patient wants to leave a nursing facility and can receive adequate living assistance at home or in a community-based setting, the program saves money.
“Most people want to be at home, or a home-like setting,’’ Kidder said.
One concern with transitioning Medicaid long-term care recipients into managed care plans is whether people will choose a health plan that’s right for them — even though the state will notify them by mail, provide a toll-free telephone number and a website for guidance, and arrange face-to-face meetings with counselors.
Laura Summer, a researcher at the Health Policy Institute at Georgetown University, co-authored a study examining Florida’s plan.
Although the state’s program is premised on Medicaid recipients having a choice of health plans, she said, “To what extent are these folks aware of what’s happening?’’
Many in the long-term care population are able to make health plan choices. “But there’s a significant proportion of those people who really won’t necessarily get the mail that’s sent to them, won necessarily open it or read it or understand it,’’ Summer said.
In the Orlando area, the first to make the change, 49 percent of the estimated 9,300 eligible Medicaid recipients selected their own health plan from four choices. Another 14 percent had previously chosen to remain in a nursing home plan. The remaining 37 percent were assigned by the state to one of the plans in the region.
There’s also a question about whether providers will choose to remain in health plan networks at Medicaid rates, which typically are lower than the cost of services.
With a private health plan now administering those dollars, some hospitals and other healthcare providers worry that they will receive even less.
But Cliff Bauer, senior vice president of operations for Miami Jewish Health Systems, said his group has contracted with several local plans and does not expect to receive less.
“We will be paid the same amount by the managed care company that Medicaid paid us prior to the managed care company coming over,’’ he said.
Miami Jewish operates a 462-bed nursing home, and also provides living assistance such as personal care assistance, adult day care, meal delivery and other services to 2,400 people in Miami-Dade and Broward.
About 300 of the nursing home residents receive Medicaid, Bauer said, and no one will be forced to leave.
“It is very clear to me that the state has no intention of forcing anybody out of a nursing home,’’ he said.
Not everyone is convinced, though.
“It’s too early to tell,’’ said Summer, the Georgetown researcher. “There are two motives that people talk about much of the time for the diversion from nursing facilities to the community. One is people really choose that. They really want to live independently. They really believe the quality of their life is going to be better. The other is the financial. It definitely costs less to serve people in the community.’’