HEALTHCARE

New Medicaid managed care system set to expand

 

More information

To learn more about the state’s Medicaid managed-care plan, visit the following Florida Agency For Healthcare Administration website: http://ahca.myflorida.com/Executive/Communications/Press_Releases/pdf/RecipientProtections.pdf


The News Service of Florida

Thousands of low-income seniors in Southwest Florida and areas of the East Coast are poised this weekend to become part of the state’s long-debated shift to a Medicaid managed-care system.

The change, which will take effect Sunday, will involve an estimated 13,450 people in 12 counties who need long-term care — most of them seniors. It is part of a gradual move that ultimately will lead to almost all Florida Medicaid beneficiaries enrolling in HMOs or other types of managed-care plans.

Approved by lawmakers and Gov. Rick Scott in 2011, the changes have long been controversial, with critics questioning the care Medicaid beneficiaries will receive. But Liz Dudek, secretary of the state Agency for Health Care Administration, said this week that state officials are trying to address questions and concerns through “outreach” to service providers and through other efforts.

“The agency and its partners are committed to making the transition to statewide Medicaid managed care as seamless as possible,’’ Dudek said in a prepared statement. “However, if there is a hiccup along the way, we have put a number of tools in place to fast-track those issues to the individuals who can make things right.”

The state has started the changes by planning to move roughly 90,000 people who need long-term care into the new system. That process started Aug. 1 in a four-county region of Central Florida and will continue until March 1, 2014. AHCA then plans to turn to enrolling the broader Medicaid population in managed care.

Lawmakers have divided the state into 11 regions to carry out the plan, with the long-term care changes taking effect Sunday in two of the regions. The counties in those two regions are Charlotte, Collier, DeSoto, Glades, Hendry, Lee, Sarasota, Indian River, Martin, Okeechobee, Palm Beach and St. Lucie.

Under the system, AHCA sought bids from health plans in each region and awarded varying numbers of contracts. In the Southwest Florida counties, the available plans are American Eldercare, Sunshine State Health Plan and UnitedHealthcare of Florida. In the East Coast counties, the available plans are American Eldercare, Coventry Health Plan, Sunshine State Health Plan and UnitedHealthcare of Florida.

Many of the new managed-care enrollees already receive care in nursing homes. But a broad goal of the program is to use managed care to provide services to help other seniors remain in their residences or communities, instead of needing to move into nursing facilities.

Groups such as AARP Florida, however, have expressed skepticism about shifting seniors into managed-care plans and have questioned the oversight of the care they will receive.

AHCA officials said they have focused heavily on issues such as trying to prevent disruptions in where people live and in the relationships between Medicaid beneficiaries and service providers. As an example, in the Central Florida region, AHCA said only one assisted-living facility declined to participate in the new system, and 10 Medicaid beneficiaries were moved elsewhere before the managed-care changes took effect Aug. 1.

AHCA will wait until Nov. 1 to make the long-term care changes in the next two regions. Broward County makes up one of those regions, while the other involves 14 North Florida counties stretching from Bay County to Madison County and including Tallahassee. Miami-Dade and Monroe Counties are part of Region 11.

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