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Statewide Medicaid managed care gets fed approval

by John Kennedy | June 14th, 2013

The Obama administration has approved Florida’s two-year-old request to move almost all of the state’s 3.3 million low-income, Medicaid patients into managed care programs, Gov. Rick Scott announced Friday.

Scott and leading Republican lawmakers have long contended that managed care will squeeze savings out of Medicaid, which this year absorbed $21 billion of the state’s $70 billion budget.

Although federal officials pay about 58 percent of the program, the pricetag for Florida taxpayers remains significant.

In its approval letter, CMS said Florida can begin the managed care conversion on a staggered, region-by-region basis no sooner than next January.

The Florida Legislature approved the managed care push in 2011. Earlier this year, the federal Centers for Medicare and Medicaid Services (CMS) approved moving thousands of nursing home and other long-term care patients into HMOs and other managed care programs as early as this fall.

“Florida is leading the nation in improving cost, quality and access in the Medicaid program. CMS’s final approval of our Medicaid managed care waiver is a huge win for Florida families because it will improve the coordination of care throughout the Medicaid system,” Scott said of the full-scale approval. “Healthcare providers can now more effectively manage chronic conditions and work with families to provide preventative treatments.”

Many health care advocates were wary of the state’s move, fearing it could lead to profit-seeking HMOs cutting corners in caring for low-income Floridians.

They cited problems with an Medicaid HMO pilot program begun in 2006 in five counties, including Broward, that was marked by widespread complaints from patients.

Florida CHAIN, a statewide health care advocacy organization based in Jupiter, had fought the conversion of traditional fee-for-service Medicaid to managed care programs.

On Friday, CHAIN said, “The focus now shifts to the state and its efforts to implement this program that will affect access to care for millions of patients in all 67 counties. The countless reports of disrupted, delayed and denied care streaming in from the original five counties are still very fresh in the minds of all stakeholders.”

CHAIN added, “Advocates will continue to monitor implementation and call on the Agency for Health Care Administration, Florida’s Medicaid agency, to put the needs of patients above the interests of companies with a strong financial incentive to limit care.”

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7 Responses to “Statewide Medicaid managed care gets fed approval”

  1. Z Says:

    As long as the insurance business is a for-profit business, the customer will get screwed. Especially when it’s the profiting party who is also making the decisions about what care and procedures are necessary. We need a not for profit medical insurance option for the citizens. Even if it has to be state sponsored. If for-profit companies can provide better care for lower cost like they claim they can, then they can prove it by competing along side the not for profit companies.

  2. wise chuck Says:

    Does this also include those seniors covered by Medcaid living long term in nursing homes?

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