Medicaid Reform Advocates Coalition Blog

The Medicaid Reform Advocates Coalition is a group of consumer advocacy organizations monitoring the implementation and effects of the Florida Medicaid Reform. MRAC coalition partners represent different constituencies affected by Medicaid Reform. MRAC ‘s mission is to ensure that consumers’ interests are safeguarded as they are enrolled in private managed care plans and that the level of care they receive is adequate and appropriate for their needs. Contact MRAC at medicaidreform@pobox.com.

Saturday, August 26, 2006

FLORIDA MEDICAID REFORM - National Conference of State Legislatures

Source: National Conference of State Legislatures
August 25, 2006

The Florida legislature took a major step in May to change the nature of the Medicaid program in the state, with an eye to controlling future program growth and introducing greater benefit flexibility for providers and consumers.


With passage of SB 838, the legislature set the state on the path to a new defined contribution managed care model to be pilot tested in two counties after federal approval of a 1115 demonstration waiver. A “defined contribution” plan means a fixed premium paid to the provider organization per plan member, rather than a “fixed benefit” model under which the provider is reimbursed for the delivery of specific services.


SB 838 calls for the Florida Agency for Health Care Administration (AHCA) to create a capitated (fixed payment) managed care system for all Medicaid recipients in fee-for-service or other managed care systems and in the MediPass (the statewide primary care case management system) program. No Medicaid-eligible populations are to excluded, although the bill calls for AHCA to develop special “service delivery alternatives” to meet the specific needs of certain disability groups. 1


In partnership with the Department of Elderly Affairs, AHCA is also directed by the legislation to create an integrated (acute and long-term care services) fixed-payment delivery system for elderly Medicaid recipients. Medicaid funding for services provided to people age 60 or older will go into the demonstration project in two areas of the state, with voluntary enrollment to be tested in one of the areas. To be excluded from the pilot are persons age 60 and older with developmental disabilities in the community or in institutions, and persons in that age group in AIDS, traumatic brain injury, and spinal cord injury waiver programs.

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We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

posted by mdubin @ Saturday, August 26, 2006