FLORIDA MEDICAID REFORM

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FLORIDA MEDICAID REFORM

• From Concept to Implementation
• Impact on Consumers

Florida CHAIN
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Florida CHAIN
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Terms You Need To Know

• AHCA Agency for Health Care Administration
• (The agency that runs Medicaid)
• SB 838 Senate Bill 838
• CMS Center for Medicaid and Medicare Services
  the federal agency overseeing Medicaid
• Waiver Request to the federal government to
  waive (make an exception to) certain sections
  of federal law so that the state can abstain
  from compliance.
• Choice Counseling Counselors hired by the state
  to assist consumers in choosing the best plan
  for themselves
• ACS The name of the Choice Counseling company
  hired by AHCA
• Enhanced Benefits Monetary credits awarded to
  beneficiaries to purchase medical services and
  over the counter supplies not offered in the
  plans
• Dual Eligible Person receiving Medicaid and
  Medicare

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How Did Medicaid Reform Come To Florida?

• Proposed by Gov. Bush
• Based on the projected rise of the cost of
  Medicaid (as of the States budget)
• Florida Legislature passed SB 838 in the 2005
  session
• Allowed AHCA to apply for a Section 1115
  Demonstration Research Waiver from the federal
  government
• Allowed Florida the flexibility to make changes
  to Medicaid outside of federal rules.

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Basic Provisions of Medicaid Reform

• Two pilot counties - Broward and Duval (with
  expansion into surrounding rural counties,
  Nassau, Clay, and Baker in July 07). Legislative
  approval required for further statewide
  expansion.
• Shifts Medicaid recipients into private managed
  care plans - HMOs and Provider Service Networks
  (PSNs).
• Allows managed care plans flexibility to change
  the scope, amount, and duration of services
  provided
• Sets a cap for each recipient based on a risk
  adjusted premium based on historical data.

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Important Dates

• July 1, 2006 Start Date (Choice Counselors
  available to answer general questions about the
  program)
• July 24,2006 First wave of 18,000 mandatory
  enrollees sent letter of enrollment, information
  about plans and given until August 18 to choose a
  plan to be enrolled by
• Sept. 1, 2006 Enrollment becomes effective
• July 2007 Expansion to Baker, Nassau, and Clay
  Counties
• July 2008 Implement specialty plans in
  authorized additional geographic areas

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Enrollment Stages

• Current Medicaid beneficiaries will be enrolled
  during a 7 month phase (beginning 9/1/06) as
  follows
• MediPass population phased in over 7 months
• (1/2 in September 2006, 1/6 each subsequent
  month)
• PSN population phased in evenly over 3 months
  (beginning 10/06)
• HMO population phased in 1/12 of their enrolled
  population for 3 months
• (beginning 10/06 then 1/4 each month beginning
  1/07)

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Mandatory Enrollees

• TANF and TANF related groups (low income
  single parent families and low income families
  with a disabled or unemployed parent)
• Aged and disabled who are NOT dual
  eligibles
• Specialty populations
• - Children with chronic conditions
• - HIV/AIDS patients

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Voluntary Enrollees

• Individuals in institutions (i.e. nursing homes)
• Foster care children
• Individuals with developmental disabilities
• Pregnant women with income above TANF poverty
  level
• Dual eligibles (Medicare and Medicaid recipients)

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Medicaid Reform Does NOT Include

• Women who are eligible for Medicaid
  due to breast/cervical cancer
• Eligible pregnant women
• Individuals 65 and over in state mental
  facilities
• Medically Needy

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Things To Know About Managed Care Plans

• Plans can change amount, duration, and scope of
  services (to control costs)
• Plans are mandated to offer core Medicaid
  services, but catastrophic coverage is optional
• Coverage offered by plans covers the same types
  of risks but does not list specific services like
  Medicaid does.

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Main Features of Medicaid Reform

• Choice Counseling
• Auto Enrollment
• Disenrollment
• Enhanced benefit accounts of up to 125 for
  healthy behaviors
• Allowable changes in cost sharing
• Opt-out to buy private insurance/benefits
• Coverage of emergency care and nursing home
• up to 30 days from eligibility to selection of
  plan.
• No more provision for 3 month retroactive coverage

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Enhanced Benefits
How Much? 125 worth of credits for healthy
behaviors What are healthy behaviors? Dental
exams Colorectal screenings Weight loss
programs What can be bought with credits?
Toothpaste Cough medicine Vitamins Saline
solution
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Evaluation

• Evaluation of reform will be submitted to the
  Legislature which will then determine whether to
  roll out to the rest of the State as part of the
  Waiver which gives it authority to do so by 2011.
• Studies
• University of Florida
• OPAGGA
• Georgetown University
• Urban Institute/Kaiser
• Florida CHAIN

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Resources

• To ask Choice Counseling questions
• 1-866-454-3959 (TYY1-866-467-4970)
• To share Medicaid reform experiences
• Florida CHAIN at 954-791-7314
• To learn what community resources are available
• www.floridamedicaidreform.org
• To get assistance with prescription drug denials
  under Medicaid
• Florida Legal Services at 1-800-436-6001

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Prepared by Florida CHAIN
May be reproduced freely with attribution to
Florida CHAIN

• www.floridachain.org