Health Plans Chosen For Florida Medicaid Makeover

January 16, 2013

In another step toward transforming Medicaid into a statewide managed-care system, the Florida Agency for Health Care Administration said Tuesday it has chosen five health plans to provide coverage to seniors who need long-term care.

The announcement came after a months-long bidding process that included HMOs and other types of managed-care plans competing in 11 regions of the state. While losing plans can still launch bid protests, AHCA expects to start using the new long term-care system in August in the Orlando area — and would gradually expand to other parts of Florida.

The state also still needs federal approval of what is known as a “waiver” for the long-term care changes, but Medicaid director Justin Senior said he is optimistic that will occur by a Feb. 7 deadline.

“The Agency has selected plans that will be able to meet the needs of the recipients we serve and be good stewards of taxpayer dollars,” AHCA Secretary Liz Dudek said in a prepared statement. “We look forward to beginning to work with the selected plans and to finalizing negotiations with CMS (the federal Centers for Medicare & Medicaid Services) for waiver approval within the next several weeks.”

Lawmakers in 2011 approved a far-reaching proposal to eventually shift almost all Medicaid beneficiaries into managed-care plans. The first phase would involve seniors who need long-term care, while a later phase would address the broader Medicaid population.

In both phases of the program, AHCA is required to contract with a limited number of plans in each of the 11 geographic regions. Along with HMOs, lawmakers called for contracting with another type of managed care known as provider-service networks.

The announcement Tuesday included selection of provider-service network American Eldercare to receive contracts in all 11 regions. The firm participates in already-existing state “diversion” programs, which are designed to help keep seniors out of nursing homes by providing services in their homes and communities.

Among the other selected plans, Sunshine State Health Plan, a subsidiary of the St. Louis-based health company Centene Corp., was selected to serve 10 regions. United HealthCare of Florida was selected for nine, while Coventry Health Care of Florida was chosen for four, and Amerigroup Florida was picked for two.

HMOs that were not chosen for contracts included prominent companies such as Humana and WellCare. If such companies want to challenge the agency’s decisions, Senior said they have 72 hours to file notices of bid protests.

“We are definitely preparing for it,” Senior said.

But Senior said he expects that the agency could continue moving forward with the selected plans even if bid protests are filed. In most regions of the state, AHCA did not choose the maximum number of plans allowed by the 2011 law. As a result, plans could be added to the system if they are successful in bid protests.

Supporters of the statewide managed-care system argue it will hold down costs while also improving the coordination of care for beneficiaries. In the long-term care portion, that includes health plans providing care that ultimately would help keep seniors from moving into nursing homes.

But Democratic lawmakers and some patient-advocacy groups have long said they fear statewide managed care will involve squeezing the services provided to beneficiaries.

“Their (supporters of the changes) motivation is money,” said Rep. Mark Pafford, a West Palm Beach Democrat who works on health-care issues. “It’s not access and quality.”

AHCA wants to gradually roll out the long-term care program, starting in August in a region that includes Orange, Brevard, Osceola and Seminole counties. It would follow in September in southwest Florida and in Palm Beach County and the Treasure Coast, before gradually expanding later to other parts of the state.

During a presentation Tuesday to the House Health Care Appropriations Subcommittee, Senior said a key challenge is helping beneficiaries in choosing the most-appropriate health plans. He said it will involve elder-advocacy groups and others playing a role in helping with the decisions.

“This is not going to be an easy undertaking over the next seven or eight months,” Senior said. “But it is one we are committed to.”

By The News Service of Florida


4 Responses to “Health Plans Chosen For Florida Medicaid Makeover”

  1. Workforseniors on January 16th, 2013 3:08 pm

    Hey Januice, while I know many people abuse the system as to many people do with any assistance. Not all abuse the system their are many people who are in great need of this Welfare and the abusers make others look bad. But that is not to categorize ALL. Anyone could be put in a situation needing Welfare, but it is put in place to temporarily aide unless other circumstances apply. That’s why people behind closed doors need to be in touch with the people who are in need to know what services are needed , and will know how to determine cost. This apply to the Welfare program as well. Back to the Health Plans for Medicaid takeover which affects our Seniors, Conservatives love the Medicaid reform program, the HMO frequently won’t provide their medications, or is slow to approve them, causing their health issues to spiral out of control, which will force them into a Nursing home or worse. The Seniors will have to participate or loose Medicaid all together. The goals of Florida’s Medicaid Reform Pilot, was proposed in 2005 under then-Governor Jeb Bush.

  2. Januice on January 16th, 2013 12:32 pm

    Well, I think that government oth to leave our Senior People alone. They have been fine up til now. They have paid their dues while they worked now gov. needs to back off and leave them the hell alone. If there needs to be a cut thats fine start with medicare. We could probably have more money to function off of if the people doing the decision making with food stamps,wic and all that gov. FUNDED programs. I’m sure that all the people on the food stamp line don’t need $400.00 for groceries, while they use their cash for cigs., drugs and beer. I’m a little fed up hearing about cutting the seniors, well they at least have paid their dues. Unlike the ones having the welfare system be a way of living.

  3. Workforseniors on January 16th, 2013 8:59 am

    This is not the best news for our Seniors in the community they will not receive the needed care only minimum. They will be forced to make a decision between HMO providers who are only looking to make a profit and not meet the better needs of our seniors. Holly Benson and others behind these doors making decisions are keeping politics involved and driving our seniors into nursing homes not keeping them in their own homes, which by the way is less cost.

  4. Jane on January 16th, 2013 7:22 am

    Don’t count on United Health Care…. it will not pay for anything it can get out of paying for!!! I know….United Health Care left me over $60,000 in debt that I am still paying off!!!

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