As acting state Medicaid director Justin Senior met with an advisory group Tuesday, he got an email on his wireless phone.
Federal officials were letting Senior know they want Florida to request another 15-day extension of a Medicaid managed-care pilot program.
The pilot was originally supposed to end June 30, but the federal government has repeatedly granted temporary extensions as Florida seeks approval to continue the program through June 2014.
"I'm going to get the whole three years, 15 days at a time,'' Senior quipped after reading the email.
The latest request from the federal Centers for Medicare and Medicaid Services is part of a multipronged waiting game as Florida seeks to transform Medicaid into a statewide managed-care program.
The pilot, which started in 2006, requires most beneficiaries in five counties to enroll in HMOs and other types of managed-care plans. But in August, the state Agency for Health Care Administration also submitted detailed proposals to the federal government for a far broader statewide managed-care system.
At this point, it's unclear when -- or if -- the proposals will be approved. Even if approved, it is unclear whether AHCA will be able to meet the Legislature's timetable for starting to move beneficiaries statewide into managed-care plans in 2013.
The proposals are broken up into what are known as "waivers,'' because Florida is asking the federal government to effectively waive parts of Medicaid law.
One of the August filings dealt with Florida's proposal to move seniors and other long-term care beneficiaries into managed care. The federal government was required to respond to that request within 90 days, or by Nov. 1.
Senior said CMS has responded -- by asking Florida for more information. Florida submitted additional information mid-October, restarting the clock on another 90-day period that will last into January.
"Hopefully they run out of questions,'' Senior told members of the Medical Care Advisory Committee, a panel that meets periodically to discuss Medicaid issues.
Perhaps even more nebulous is the timing of a federal decision about statewide managed care for the bulk of Medicaid recipients, such as children and women.
Technically, the state proposed that expansion as an amendment to the federal waiver that created the five-county pilot program. Senior said he thinks discussions will not start on the amendment until after CMS decides whether to approve three more years of the pilot.
Another wildcard in AHCA's attempts to get approval for the managed-care expansions is that Democratic lawmakers and a wide range of interest groups oppose the changes.
But first, AHCA is waiting for a decision about the pilot program, which operates in Broward, Duval, Clay, Baker and Nassau counties. The latest extension is scheduled to expire Oct. 31, but the email Senior received Tuesday indicates that date will be pushed into mid-November.
The remaining hang-up in negotiations is a question about the future of Florida's Low Income Pool program, which is part of the pilot and funnels $1 billion a year to hospitals and other providers that serve large numbers of low-income and uninsured people.
Federal officials are considering ending the so-called LIP program --- and similar programs like it nationally --- in December 2013. That would cost Florida providers as much as $500 million, because the pilot would last through June 2014.
Despite the LIP question, federal officials have repeatedly signaled they want to extend the pilot program.
"We appreciate the time that you and your staff have dedicated to the renewal process and look forward to working with you to finalize the extension of the Florida Medicaid reform demonstration,'' CMS said in an Oct. 14 letter to Senior.
