by Jim Saunders
The News Service of Florida
Florida’s Medicaid overhaul would not start shifting people into managed-care plans until 2013 and would use a controversial pilot program as a springboard, according to hundreds of pages of documents released Tuesday.
The documents are Florida’s detailed proposal for carrying out new state laws that would eventually require almost all beneficiaries to enroll in managed-care plans.
The state Agency for Health Care Administration sent the proposal Monday to federal Medicaid officials.
Supporters hope the federal government will sign off on the proposal, which they say would help control costs in the $21.2 billion Medicaid program and improve care for beneficiaries.
“What Florida’s proposing really is at the vanguard of what states are doing, and a lot of states are looking at Florida,’’ said Senate Health and Human Services Appropriations Chairman Joe Negron, a Stuart Republican who was an architect of the plan.
Opponents are worried about requiring Medicaid beneficiaries statewide to enroll in HMOs or other types of managed-care plans. Some, including Democratic legislative leaders, want the federal Centers for Medicare and Medicaid Services to reject the proposal.
Senate Minority Leader Nan Rich (D-Weston) said she is concerned about the ability of managed-care plans to serve low-income people who have severe medical needs, including seniors who need long-term care.
“In and of itself, it (requiring seniors to enroll in managed care) gives me heartburn because this is an extremely vulnerable population,” said Rich.
Lawmakers approved a two-bill package in May, with a goal of moving roughly 3 million Medicaid beneficiaries into the new mandatory managed-care system by October 2014.
The Agency for Health Care Administration appears to have closely followed the Legislature’s direction in putting together the proposal.
The documents also fill in details about how the state would transform the Medicaid system and how it hopes to convince the federal government to go along.
As an example, one of the new laws says the agency will begin “implementation” of the managed-care program for seniors next July, but the documents make clear that seniors would not start enrolling until early 2013 because of the process of awarding managed-care contracts.
Similarly, the law says the agency will begin “implementation” of statewide managed-care for a broader Medicaid population in January 2013, but the documents indicate people would not start enrolling until late 2013 at the earliest.
The documents request a series of approvals for what are known as “waivers” to federal Medicaid laws. The state is seeking two new waivers, which are intertwined, so it can require seniors to enroll in managed care.
The state also is seeking an amendment to an existing waiver so that it can require managed-care enrollment for the broader Medicaid population, such as women and children.
That move quickly spurred criticism Tuesday, because the state uses the existing waiver to operate a Medicaid “reform” pilot program that requires most beneficiaries in five counties to enroll in managed care.