Long-Term Care Industry Wants Out Of Managed Care

Jan 11, 2017

Florida’s long-term care industry group says the state’s Medicaid Managed Care system isn’t quite working for it. And it wants long term care to be carved out of the system. The state long-term care association brought its complaints to a state healthcare committee Tuesday.

The Florida Healthcare Association wants to be clear. Association lobbyist Debra Franklin says the Medicaid managed care system is working for the majority of people it serves. But when it comes to the nearly 100,000 people in long-term care such as nursing homes:

Managed Care is often late in paying these claims. One resident, it was $45,000 that for almost a year we’ve tried to get paid. It’s been a nightmare," Franklin says.

At issue is a problem getting paid on time. She says facilities have trouble juggling paperwork to submit to multiple insurance companies—money that could be spent elsewhere. And she says one nursing home has more than $400,000 dollars’ worth of outstanding claims.

“That’s a not-for-profit where the funds go right back to patient care. I’m sorry, but just changing to multiple payment plans is not the issue here.”

Long-term care is expensive, and the reason it was included in the state’s Medicaid managed care system was to save the state money by improving health outcomes and moving people out of nursing homes and getting them into home and community based care programs.

But there’s long been unease about whether long-term care should even be included in the program given that patients tend to be sicker. Still, Interim Medicaid Director Beth Kidder argues payment issues are largely in the past, and she doesn’t think long-term care should not be carved out of the overall managed care system.

“Please don’t misunderstand. There’s still a place for nursing care facilities. They do wonderful care and they’re very much needed," Kidder says. "But we’ve seen in other states is that you can shift the percentage much lower than we have it in Florida. We believe the best way to do that is to keep the entire continuum together so that all the incentives are in the right place.”

Meanwhile the Florida Association of Health Plans says it’s been working with the long-term care industry to resolve payment problems. Association Director Audrey Brown says the example of non- payment provided by FHCA’s Franklin isn’t widespread.

“I don’t think you can paint this with broad brush. I think the vast majority of the health plans are paying timely. And those outstanding issues-I know the agency wants to resolve those, we want to resolve them, and we want to do it so providers can get paid. They deserve to get paid, they provide great service, and we’re here to do that.” 

The Agency for Healthcare Administration says overall complaints about the program are very low. Medicaid has become the biggest cost driver for the state, and Florida lawmakers are trying to figure out how to get control of the program’s rapidly growing costs. Managed Care was billed as a solution to that. But even as the cost per-person has gone down, the overall bill continues to rise. The program goes up for renewal before the federal government this year, and Governor Rick Scott wants the feds to increase its Medicaid funding to the state.