Florida’s Medicaid Program History

Florida’s Medicaid Program History

Rationale

Florida’s Medicaid reforms initiated in 2006 aimed at statewide coverage expansion of the managed care system. In 2005, former governor, Jeb Bush, signed into law a federal waiver proposal to move recipients from the fee-for-service model to managed care (Senior, 2016). The rationale for this healthcare reform was to expand coverage to over 4 million uninsured Floridians to lower the percentage of the uninsured (Senior, 2016).

Adoption of the Reform

Managed-care plans were adopted in Florida after the approval of the federal waiver proposal on June 3, 2005. The permission followed Governor Jeb Bush’s push for a ‘Section 1115’ Medicaid Waiver from the national government to reform the state’s Medicaid program (Senior, 2016). The goal was to promote competitive health care benefits through risk-adjusted premiums for recipients. The resulting plans would offer the mandated services but allow for adjustments related to payment, period, and range of products Floridians would receive.

Since 2006, children from poor households, expectant mothers, disabled persons, and the elderly were enrolled in a Medicaid waiver pilot implemented in five counties (Senior, 2016). The recipients could receive primary and acute care services through managed care or provider-funded organizations. The program also included flexible, cost-shared benefits for the low-income pool (LIP). It entailed mandatory enrollment of the elderly, disabled persons, and poor households, and foster children (Senior, 2016). These groups qualified for full Medicaid benefits. Presently, under this plan, persons with long-term care (LTC) needs qualify for post-acute and primary care benefits (Senior, 2016). These services are offered through Health Maintenance Organizations and Provider Service Networks engaged in the LTC program as prescribed in the waiver.

After prolonged discussions with the Center for Medicaid and Medicare Services (CMS), Florida received the approval to shift to managed care plans in 2013. Subsequently, a statewide expansion of this program commenced with the launch of the Statewide Medicaid Managed Care (SMMC). The SMMC program comprises two parts: “Long-term Care (LTC) and Managed Medical Assistance (MMA)” (Senior, 2016, p. 2). The first component expands LTC services to all Medicaid-covered populations through the Nursing Home Diversion program (Senior, 2016). In 2013, the state began a phased transfer of Medicaid recipients to LTC managed care, completing it in 2014. The MMA program increased the coverage of the pilot waiver from five sites to statewide health care. Under this plan, comprehensive Medicaid benefits are available to all participants, except those enrolled in the “family planning programs, breast and cervical cancer services, and pediatric care” (Senior, 2016, para. 7).

Since the 1990s, Florida has been implementing a case management plan known as MediPass (Senior, 2016). Under this program, about 600, 000 enrollees could access care from 5, 000 healthcare organizations. Those with chronic conditions received services from subcontracted providers. However, as of August 2014, the state began to move MediPass beneficiaries to the managed care program (Senior, 2016). Under this program, Medicaid-covered children are eligible for either DentaQuest or MCNA Dental for their dental care needs (Senior, 2016). Florida’s MMA aims to improve quality, enhance access, and reduce spending. It also seeks to strengthen care coordination, expand benefits for enrollees, and manage costs.

Funding Structure

The Medicaid budget is financed through state and federal funds – a joint funding structure. This financing model ensures better responsiveness to state priorities and needs. In 2014, Florida spent $23bn on its Medicaid program with $9. 5bn coming from state funds (Snyder & Rudowitz, 2015). The remainder ($13. 5bn) came from the federal disbursements through the Federal Medical Assistance Percentage (FMAP), enhanced matching rates, and Disproportionate Share Hospital (DSH) programs. FMAP matches national allocations with each $1 spent by the state on Medicaid. Thus, this funding model responds to the actual expenditures and needs of the beneficiaries. In 2014, for every dollar Florida allocated to this program, the central government gave $1. 43 (Snyder & Rudowitz, 2015). The statewide expansion of Medicaid calls for enhanced matching rates to cater for the high number of beneficiaries. In particular, the Affordable Care Act (ACA) extends the eligible populations, resulting in additional costs. According to Snyder and Rudowitz (2015), federal funding of the ACA Medicaid expenditures stands at 100%, to be phased down to 90% by 2020. There is also an administrative matching rate ( <5%>

DSH payments are given to healthcare organizations serving a disproportionate number of Medicaid recipients and poor Floridians without medical insurance. This form of financing has played a role in stabilizing the ‘safety net’ of providers. However, under the ACA, DSH payments are set to decline beginning in 2018 due to lower “uncompensated care costs” related to expanded Medicaid coverage (Snyder & Rudowitz, 2015, para. 12). In addition to federal funds, the state also contributes to this program. The non-federal funds going into Medicaid primarily comes from the state coffers. In 2014, Florida appropriated $9. 5bn (41%) to Medicaid spending with the remainder coming from the federal allocation (Snyder & Rudowitz, 2015). Flexibility is required to cater to competing priorities. Over the years, Florida has enhanced its share of the Medicaid budget through provider capitation.

Impacts

The Medicaid Reform Program has had a serious effect on healthcare coverage and shipping in Florida. Among 2006 and this year, about 1. eight million persons (uninsured and underinsured groups) received inpatient treatment with another ten. 8 million benefitting from outpatient solutions in Floridian private hospitals (Duncan, Hall, Harman, Bell, & Kinsell, 2015). Those offered by non-hospital companies rose by 255, 500 to 694, 300 individuals on the same period. Medical center care included analysis and radiology solutions, surgeries, emergency treatment, etc. The 35 dollars million LIP system has had the significant effect on entry to care simply by poor households plus Medicaid eligible individuals. About 60% associated with LIP’s tier 1 and tier 2 initiatives have affected health care usage by these foule (Duncan et ing., 2015). The quantity of patients getting Enhanced Benefits Accounts (EBA) credits with regard to engaging in healthful behaviors – doctor visits, PSA assessments, etc . – offers increased in Fl, earning them $37 million between the year 2010 and 2014 (Duncan et al., 2015). There has recently been a growth inside services, providers getting LIP, and improved matching rates plus healthcare utilization.

The particular expansion has experienced an impact upon healthcare costs inside Florida. Now, the particular financial burden associated with providing care will be shared between the particular hospital and non-hospital organizations. Thus, the particular expansion has decreased the cost associated with uncompensated care that will was previously paid for by hospitals by yourself. The estimated cost savings from the extended coverage are regarding $1. 3 billion dollars (Duncan et ing., 2015). The end result from the shift in order to managed care is usually improved solvency within Florida’s healthcare program. The expansion arrived with increased Medicaid allocation – $9. 5bn in 2014. The federal money have fuelled the growth of Florida. Medicaid injected $8. nine billion to the particular local economy plus created over 71, 000 employment possibilities in 2014 (Duncan et al., 2015).

References

Duncan, L. P., Hall, The. G., Harman, M. S., Bell, T. L., & Kinsell, H. S. (2015). Fl Medicaid reform evaluation: Last low income swimming pool milestone statistics plus findings report with regard to DY8: SFY 2013–14 . Gainesville, FL: University of Fl.

Senior, J. M. (2016). Florida Medicaid: Statewide Medicaid managed treatment . Web.

Snyder, L., & Rudowitz, R. (2015). Medicaid financing: So how exactly does this work and what are the ramific

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