Florida's overhaul of the Medicaid system likely will take longer than expected, with some beneficiaries not enrolled in HMOs or other types of managed-care plans until 2015, according to a revised state timeline.
A 2011 law and documents submitted in August to the federal government indicated that seniors who need long-term care would be shifted into health plans by Oct. 1, 2013, and that the broader population of Medicaid beneficiaries would follow by Oct. 1, 2014.
But the Agency for Health Care Administration recently revised the timeline and moved back each of those dates by six months. Enrollment, however, would be phased in, so some beneficiaries would still go into managed-care plans in 2013 and 2014.
AHCA has been working for months to get approval from the federal government to make the changes. It also will have to contract with varying numbers of managed-care plans in 11 regions of the state and, ultimately, will have to help oversee hundreds of thousands of beneficiaries moving into the new system.
In response to questions about the revised timeline, agency spokeswoman Michelle Dahnke said in an email Wednesday that the agency is "moving forward to enroll recipients as quickly as possible while ensuring the highest level of responsiveness to our recipients and the highest quality of services."
Michael Garner, president of the Florida Association of Health Plans, which represents HMOs, said the extra time could cause some changes in his members' business models. But he said if it can help avoid "hiccups along the way, it is worth it."
"In the end, I believe what's most important is that it is implemented correctly,'' Garner said.
Lawmakers last year approved shifting almost all Medicaid beneficiaries into managed-care plans, with supporters arguing the move would save money and better coordinate care. The changes are controversial, as some critics argue that for-profit HMOs will not provide the care that beneficiaries need.
Regardless of the back-and-forth debate, moving to a statewide managed-care system is a complicated process.
The 2011 law required that changes take place first in the long-term care part of Medicaid. It said AHCA should release what are known as "invitations to negotiate" --- a key initial step in the contracting process --- by July 1, 2012, with the long-term care program fully implemented "in all regions by Oct. 1, 2013."
Similarly, it required that invitations to negotiate for the part of the program dealing with the broader Medicaid population be released by Jan. 1, 2013, "with full implementation in all regions by Oct. 1, 2014."
Justin Senior, deputy secretary for Medicaid, said this week that AHCA is on schedule for releasing the invitations to negotiate. He said it can start that process, even though federal officials have not signed off on the changes.
The revised timeline, however, says that all long-term care beneficiaries would be enrolled by April 1, 2014, and all beneficiaries in the broader population --- such as low-income women and children --- would be enrolled by April 1, 2015.
By Oct. 1, 2013, the new timeline calls for long-term care beneficiaries to be enrolled in managed-care plans in at least one region. It has a similar requirement in Oct. 1, 2014, for the broader population.
In responding to questions Wednesday, AHCA did not provide a detailed explanation for extending the amount of time.
"The state wants to ensure that our recipients have every opportunity to be fully informed of their options under this new program,'' Dahnke said in the email. "It is critical that the plans participating in the program are chosen with deliberation and that they are fully certified as ready to serve enrollees before implementation begins."
Garner pointed to reasons such as the time AHCA needs to review proposals from health plans, negotiate contracts, notify beneficiaries and hold public meetings. He said he has not seen indications that the ongoing negotiations with the federal government have led to the revised timeline.
But in a series of questions sent to the state in January, the federal Centers for Medicare and Medicaid Services signaled that it has looked at how quickly the new program could move forward. It cited part of the state's proposal last year that indicated people in the broader Medicaid population would be enrolled in managed care between April and October 2014.
"Please provide the strategy with timelines and discuss how it will be logistically possible to transition the anticipated number of beneficiaries, from fee-for-service to between 30 to 50 managed-care plans over a six-month time period, while ensuring continuity of care for all beneficiaries,'' federal officials said in the document.
