Feds Want More Consumer Protections As Condition of Statewide Medicaid Managed Care Approval

Feb 20, 2013

The federal Centers for Medicaid and Medicare Services has moved closer to granting Florida permission to transition the state's Medicaid program into a managed care system.

The move means the state will no longer pay individual providers on a fee-for-service model, but will hand over billions of dollars to insurance companies, which will contract with local providers, hospitals, and nursing homes.

Medicaid, which makes up the bulk of the state's healthcare spending,  is a federal and state partnership program that provides insurance to about three million low-income women, children, disabled and elderly Floridians. The plan is aimed at controlling costs in the $21 billion program, which critics say is cutting into funding for other parts of the state budget like Education.

“This is a great win for Florida, and it would not have been possible without the support of legislators who began the fight for this Medicaid flexibility many months ago.  Improving the coordination of care in Medicaid means we will be able to better-manage chronic conditions and give more preventative treatments to help keep Florida families healthy," Governor Rick Scott said in a press release.

"When I met with Sec. Sebelius in Washington, D.C. in January, I stressed the importance of the state receiving flexibilities in our current Medicaid program through the long-term care waiver and this medical assistance waiver for the implementation of the Statewide Medicaid Managed Care Program. Getting this waiver approved by HHS, just after our long-term care waiver, makes us two-for-two in our request for Medicaid flexibilities. This helps Florida taxpayers by lowering costs and Florida families by improving healthcare services.”

Scott has pinned another major Medicaid decision-- whether to expand access to the program to even more Floridians- to whether the state got the Managed Care waiver.

In a letter to the state, CMS said it agreed "in principle" with Florida's request to move Medicaid into a managed care system, but is looking for additional terms and conditions on how the program is implemented.

Some of those terms include a greater role for consumer advocates, who say they've been kept out of loop.

"We still believe it's better to not force people into managed care, but this is better than not," said Karen Woodall, Executive Vice President of the Florida Center for Fiscal and Economic Policy.

Woodall says the letter from CMS is a step forward, but doesn't amount to full approval of the program.

Check back later on for more on this story.

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