Medicaid patients face changes in health plans
Tuesday, September 18, 2018
Posted by: DCMS
The News Service of Florida
By Christine Sexton
TALLAHASSEE --- About 600,000 low-income patients will be assigned to new Medicaid managed-care plans in the coming months after the state ended contracts with their existing plans.
Agency for Health Care Administration spokeswoman Mallory McManus told The News Service of Florida that roughly 20 percent of enrollees in the broad Medicaid “managed medical assistance” program and 12 percent of enrollees in managed long-term care are “impacted” by the changes, meaning they are enrolled in health plans that no longer will be offered.
Those patients will be assigned to new health plans, Medicaid director Beth Kidder said last week during a webinar held for health providers and other people interested in the transition from existing managed-care plans to new plans.
Kidder said Medicaid beneficiaries will receive letters from the state about six weeks before the changes are slated to take effect advising them of new assignments. Kidder said patients will be given the opportunity to switch from the health plans to which they are assigned.
Within 48 hours of announcing the webinar, more than 500 people signed up to participate, Kidder said. The state responded to the demand by doubling to 1,000 the number of people who could attend the meeting. See presentation.
AHCA has been hesitant to say how many patients would be impacted by the contract changes, and Kidder didn’t provide estimates during the webinar for “impacted” and “non-impacted” patients.
When pressed for details, AHCA said an estimated 20 percent of the people enrolled in the statewide Medicaid managed medical-assistance program --- which generally provides acute care --- and 12 percent of the people enrolled in the long-term managed care program were enrolled in health plans that will not have contracts with the state.
As of August, there were 3,075,646 people in the managed medical-assistance program and another 102,539 people in the long-term care program. McManus cautioned against adding the populations together saying that there are some people who are in both programs and that adding the populations could result in people being counted twice.
To ensure that the impacted Medicaid patients won’t be hurt by the changes in health plans, they will continue to be able to see their former providers for a short period of time. Kidder said the state will require the newly contracted Medicaid plans to reimburse for care provided by the former plans’ providers for up to 60 days.
Florida Policy Institute analyst Anne Swerlick, who has long watched the Medicaid managed-care program, said her group worries about the transfer of so many patients. Swerlick said that the nonpartisan institute has “big concerns-- particularly for people who have complex illnesses and chronic conditions.”
The vast majority of Medicaid beneficiaries, though, are considered “non- impacted,” meaning they are enrolled in health plans that will continue to have contracts with the state. Kidder said during the transition the state will re-assign patients to the same Medicaid HMOs if the state is continuing to contract with the plans.
Nevertheless, non-impacted patients also are being sent letters to discuss other changes being made to the program. Even though they aren’t being moved to new plans, they will have the opportunity to switch if they want reassignment, Kidder said.
Florida lawmakers in 2011 approved a major revamp of the Medicaid program that requires most beneficiaries to enroll in managed-care plans. The state contracted with various numbers of plans in 11 regions. But with the initial contracts ending, the state went through a lengthy procurement process that led to AHCA this spring awarding a new set of contracts.
The state will mail letters to Medicaid recipients in Miami-Dade, Broward, Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie counties in October outlining the changes. The transition from old plans to new plans in those areas, known as Medicaid regions 9, 10 and 11, will be completed by Dec. 1, according to the state.
Medicaid patients living in Medicaid Regions 5,6,7 and 8 will receive transition letters in November. The area includes Charlotte, Collier, DeSoto, Glades, Hendry, Lee, Sarasota, Brevard, Orange, Osceola, Seminole, Hardee, Highlands, Hillsborough, Manatee, Polk, Pasco and Pinellas counties. According to the state they will be transitioned by January.
Patients in other areas of the state will be transitioned in February. In all, the new five-year Medicaid contracts are valued at upward of $90 billion.