Florida Medicaid Reform

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Florida Medicaid Reform

• Thomas W. Arnold
• Deputy Secretary for Medicaid
• Presented to the Academy of Medicine
  Jacksonville/ Duval County Medical Society
• February 23, 2007

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MedicaidA State and Federal Partnership

• In 1965, the federal Social Security Act was
  amended to establish two major national health
  care programs
• Title XVIII (Medicare).
• Title XIX (Medicaid).
• Medicaid is jointly financed by state and federal
  funds.
• States administer their programs under federally
  approved state plans.
• States must submit a Medicaid State Plan to the
  federal Centers for Medicare and Medicaid
  Services (CMS).
• Mandatory eligibility groups and services must be
  covered.
• Services must be available statewide in the same
  amount, duration and scope.

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Florida Medicaid A Snapshot
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Medicaid Structure

• Medicaid does not cover all low income
  individuals.
• Medicaid serves the most vulnerable in Florida
• 12 of the total population
• 27 of children.
• 51.2 of deliveries.
• 63 of nursing home days.

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Florida Medicaid Reform
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Why Is Medicaid Reform Necessary?

• Under traditional fee-for-service Medicaid
  consumers have few choices and few
  opportunities to participate in health care
  decisions.
• Lack of access to specialists.
• The traditional program is complex and hard to
  manage.
• Florida operates 20 different waiver programs
  (examples include Prepaid Mental Health, Healthy
  Start and Prepaid Dental, etc.).
• In addition, the state covers over 44 services
• We must control the growth of expenditures left
  unchecked by Medicaid will make up 59 of the
  states total budget by the year 2015.
• We must have a system that focuses on improving
  the health of beneficiaries, not just paying
  claims when people are sick.

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What Florida Intends to Achieve

• Competition-inspired innovation and efficiency.
• Plans customized to meet the needs of specific
  Medicaid groups.
• Beneficiaries can select the plan that best meets
  their needs.
• Beneficiaries control disposition of premium
  dollars.
• Providers receive more appropriate reimbursement
  for services given.

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What Florida Intends to Achieve (continued)

• Greater access to care for beneficiaries, offered
  through managed care entities.
• Better patient-doctor relationships, initiated by
  the beneficiary choice of health care coverage.
• More control given to beneficiary through
  increased transparency in the process.
• Healthier population as a result of financial
  incentives associated with Enhanced Benefits
  Program.

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Authorization for Reform

• The Agency has been authorized through Section
  409.91211, Florida Statutes to
• Seek experimental, pilot, or demonstration
  project waivers, pursuant to s. 1115 of the
  Social Security Act, to create a statewide
  initiative to provide a more efficient and
  effective service delivery system that enhances
  quality of care and client outcomes in the
  Florida Medicaid program.
• Implement the program in Broward County and Duval
  County.
• Expand into Baker, Clay, and Nassau Counties
  within 1 year after the Duval County program
  becomes operational.

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Outreach to Plans, Providers, Beneficiaries and
Advocates

• Outreach
• Prior to passage of reform, during development
  stage
• Prior to implementation of first phase
• Follow up after implementation of first phase
• Prior to implementation of second phase
• Ongoing.
• Targeted outreach to potential health care plans,
  Medicaid providers, beneficiaries, advocates,
  agencies and elected officials/community leaders.

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Outreach to Plans, Providers, Beneficiaries and
Advocates

• Training sessions held, specific to provider
  audiences such as MediPass Providers, Pharmacy
  Providers, Behavioral Health Providers, and other
  Specialty Providers.
• Articles Published in The Florida Medicaid
  Provider Bulletin.
• Announcements of public meetings broadcast in the
  Florida Administrative Weekly and to an
  interested parties list.
• Technical Assistance Meetings held with focused
  topics to guide the plans through the Reform
  process.
• RV Banners Published.

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Key Elements of Reform

• Outreach Efforts.
• Choice Counseling.
• Delivery System
• Coordinated Systems of Care (Health Maintenance
  Organizations and Provider Service Networks).
• New Options / Choice
• Customized Plans.
• Enhanced Benefits.
• Opt-Out.
• Financing
• Premium Based.
• Risk-Adjusted Premium.
• Comprehensive and Catastrophic Component.
• Low Income Pool (LIP).

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Choice Counseling

• A free service to help beneficiaries understand
  their plan choices and make a choice that best
  fits their health care needs.
• Certified Choice Counselors.
• Florida has the only certified program in the
  nation.
• On-line 10 module course.
• Comprehensive written exam.
• Oral examination with live scenarios.
• 60 Certified Choice Counselors (44 call center,
  16 field counselors).
• The call center staff serve both Broward and
  Duval.
• 10 field counselors in Broward.
• 6 field counselors in Duval.

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Call Center Statistics(July 24 through January
31, 2006)

• Total Calls received 105,827
• Total outbound calls 27,001
• Average talk time 6.5 minutes
• Average speed to answer all calls 19,67
  seconds
• Percent of calls answered within 15 seconds
  84.47
• Percent of calls answered within 60
  seconds 89.41
• Percent of calls answered within 180
  seconds 98.32
• No blocked calls since Call Center began Choice
  Counseling.

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Total Reform Enrollment Broward and Duval
Counties

• Transition period
• September 1, 2006 7,604
• October 1, 2006 47,520
• November 1, 2006 79,724
• December 1, 2006 106,873
• January 1, 2007 129,073
• February 1, 2007 148,791
• Total 148,791
• Broward 89,477
• Duval 59,314
• Remaining population to be phased in through
  March, 2007.
• Enrollment of new eligibles continues from that
  point forward.

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Enhanced Benefits

• Beneficiaries began earning credits September 1,
  2006
• First healthy behaviors were reported by Plans
  October 10, 2006.
• First credits were posted to accounts November 1,
  2006.
• Enhanced Benefits call center went live, November
  1, 2006.
• First account statements sent to beneficiaries
  (who have reported approved healthy behaviors)
  November 6, 2006
• Over 20,000 beneficiaries have received credits,
  totaling 682,712 in credit dollars, for healthy
  behaviors to date.
• Beneficiaries have made purchases with earned
  credits.

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Reform Timeline Year Two

• Authorized to expand into Baker, Clay, and Nassau
  Counties within 1 year after the Duval County
  program becomes operational.
• October 2006 Targeted Outreach to beneficiaries
  in Baker, Clay and Nassau Counties begins.
• November 2006 Letter sent to health plans
  inviting them to submit their (non-binding)
  letter of intent to the Agency to participate
  in Medicaid Reform expansion.
• December 2006 Application for Reform Plans in
  Baker, Clay and Nassau Counties available.

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Reform Timeline Year Two

• February 2007 Brochures and Area Office
  Training Schedule flyers mailed to
  beneficiaries.
• May 2007 Second mailing of brochures and Area
  Office Training Schedule to beneficiaries.
• July 2007 Choice Counseling hotline available
  for beneficiaries in Baker, Clay and Nassau
  Counties.
• September 2007 Enrollment to begin in Baker,
  Clay and Nassau Counties.

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Questions?