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Florida Moves Toward Initial Medicaid Changes

July 25, 2011 - 6:00pm

Floridas Agency for Health Care Administration began making plans to move the states long-term care Medicaid recipients into managed care plans Tuesday, but it has until Monday to submit the federal waiver request necessary to implement the changes.

The move of long-term care patients into managed care plans is part of the fundamental Medicaid reforms passed by the Legislature this year.

Under the reforms, Floridas 2.9 million Medicaid recipients will move into managed care plans in 11 different regions throughout the state. Long-term care patients will begin the transition July 1, 2012 and will be completed by Oct. 1, 2013. Other Medicaid recipients will begin their shift into managed care plans on Jan. 1, 2013, with the transition completed by Oct. 1, 2014.

AHCA officials set up an advisory board to help implement the transition of long-term care patients. The 10-member board will include doctors, lawyers and health care organization officials, and will help determine Medicaid eligibility and provider payment requirements under the reforms.

The move to managed care for long-term Medicaid patients wont begin for another year, but the new advisory board expressed concern about getting rules developed before the Legislature heads into session in January.

I also want to be careful that we dont try to rush through the process just to meet a January deadline, cautioned Michael Garner, president of the Florida Association of Health Plans.

Patients under Medicaid waivers for assisted living, aged and disabled adults, consumer-directed care, adult day health care and nursing home diversion will be moved into managed care plans beginning next summer. A review board known as CARES will also determine whether a patient is medically eligible for the long-term managed care program.

New long-term managed care patients will have 30 days to pick a plan in their region and 90 days to switch their plan if they wish to change. Floridas 11 regions will have a minimum of two plans to choose from in each region, with more populous regions having a minimum of three or five.

All of these changes, however, assume federal approval in the form of a waiver. AHCA must submit the waiver request to the federal Center for Medicare and Medicaid Services (CMS) by Monday.

The Agency continues to work onthese documents and anticipates a timely submission by the Aug. 1 deadline, AHCA communications director Michelle Dahnke stated in an e-mail. Waiver documents will be available here by noon on Aug. 2, she added.

A waiver for a five-county pilot program is about to expire Sunday. The program is similar to the statewide move to managed care, but lawmakers say they have included controls to ensure health care quality and access that arent in the pilot program. AHCA already received a one-month extension in June, but expects another short-term extension if CMS does not grant its three-year waiver request.

The Agency is currently working with federal CMS to gain approval of a three-year extension of this waiver. If agreement is not reached by July 31, we anticipate a short-term extension would be appropriate as we continue discussion about final terms of a waiver extension, Dahnke said.

Reach Gray Rohrer at or at (850) 727-0859.

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