With a June 30 deadline looming, discussions about continuing Floridas Medicaid pilot program appear headed to overtime.
The Agency for Health Care Administration sent a letter to the federal government Monday seeking a 30-day extension of the pilot, as state and federal officials try to reach agreement on continuing the program for three more years.
Phil Williams, AHCAs assistant deputy secretary for Medicaid finance, said the federal Centers for Medicare and Medicaid Services requested the letter. He said extra time is needed to fine tune details of the agreement.
This temporary extension will ensure continued service delivery to Medicaid recipients and provide additional time for the state and the Centers for Medicare and Medicaid Services to finalize key details, the letter said.
The controversial pilot, which requires most Medicaid beneficiaries in five counties to enroll in managed-care plans, is scheduled to expire June 30. The pilot started in 2006.
CMS made clear in a letter to state Medicaid officials last August that it wanted changes in the pilot.
Williams expressed optimism that a three-year extension ultimately will be approved. That includes a continuation of the Low Income Pool program, which provides $1 billion a year to hospitals and other providers that serve uninsured and low-income patients.
AHCA officials have said in the past that CMS was looking at the Low Income Pool, which was approved as part of the pilot and is closely monitored by the hospital industry.
Lawmakers last year required AHCA to seek an extension of the pilot, amid efforts to more broadly overhaul the Medicaid program.
AHCA also faces an Aug. 1 deadline for submitting a proposal to the federal government for a larger overhaul, which would require almost all Medicaid beneficiaries statewide to enroll in managed-care plans by October 2014.
The pilot, which was a priority of former Gov. Jeb Bush, operates in Broward, Duval, Clay, Baker and Nassau counties.
Supporters point to managed care as a way to control Medicaid costs and provide better access to treatment. But critics have long blasted the pilot because of problems such as HMOs pulling out of the program and disrupting care for beneficiaries.
AHCA and federal officials have been holding regular conference calls to try to agree on changes to the pilot.
Along with the Low Income Pool, Williams said one example of an issue they have discussed is what is known as an opt out in the pilot program. That allows beneficiaries to enroll in health plans sponsored by their employers, with Medicaid funds being used to pay premiums.
Williams said the federal government has agreed to continue the opt-out part of the program but is requiring that Medicaid cover services for pregnant women and children that might not be included in employer-sponsored plans.
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