AHCA serves up more details about Medicaid plan

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Nearly a year after lawmakers approved moving to a statewide Medicaid managed-care system, the Agency for Health Care Administration last week sent another round of detailed information to federal officials about how the plan would be carried out, reports Jim Saunders of the News Service of Florida.

The information, in a document dated Friday, indicates that the number of beneficiaries enrolled in HMOs and another type of managed-care plan is expected to double — and possibly triple — by the end of 2014.

Also, with the state divided into 11 Medicaid regions, it says beneficiaries would move into managed-care plans in a “staggered” fashion and that timelines would be developed for each county.

AHCA also gave assurances that health plans would have sufficient networks of medical providers and that it would require “reasonable” access to pharmacy services — and issue that particularly has concerned pharmacy owners in rural areas.
The document responds to a series of 42 questions that the federal Centers for Medicare & Medicaid Services sent to Florida in January. The federal agency must give approval before the proposed changes can take effect, as Medicaid is governed largely by federal law.

The Republican-controlled Legislature last May approved shifting to a statewide managed-care system, arguing that the change would help control costs and better coordinate care for beneficiaries. But the plan is highly controversial, with some advocates for Medicaid beneficiaries worried that it would be disruptive and make it harder for people to get care.

AHCA sent two wide-ranging plans to the federal government in August —- one dealing with seniors who need long-term care and the other dealing with the broader Medicaid population. The additional information sent last week deals only with the broader population, which includes people such as children and mothers.

Much of the information focuses on relatively obscure details. But the details are important as the state tries to change the way health care is provided to hundreds of thousands of low-income people and ensure that managed-care plans operate properly.

Currently, Medicaid beneficiaries are split between managed-care plans and what is known as a “fee-for-service” system. That system involves paying doctors and other providers based on each service they provide.

The document sent to the federal government gives a flavor of how much change would take place in the new system. It said about 1.2 million people were enrolled in Medicaid managed-care plans in September 2011, but that number is projected to jump to nearly 2.7 million by the end of 2014.

The total would go even higher — to more than 3.6 million — if part of the 2010 federal overhaul is upheld by the U.S. Supreme Court. That part of the overhaul, which Florida opposes, would expand Medicaid eligibility to more people.

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including SaintPetersBlog.com, FloridaPolitics.com, ContextFlorida.com, and Sunburn, the morning read of what’s hot in Florida politics. SaintPetersBlog has for three years running been ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.