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State Health Reform Plans Include Medicaid Managed Care

Some of Florida’s most vulnerable residents — the frail elderly and poor or disabled adults — will be ushered into a new era of healthcare over the next five months that will change the way they receive their taxpayer funded long-term care from Medicaid, the federal-state program for the poor and disabled.

These residents, about 90,000 statewide including an estimated 25,000 in Miami-Dade, Broward and Monroe counties, soon will have their living assistance services managed by a private insurance company as Florida health officials roll out an ambitious reform of Medicaid that began Thursday in the Orlando area with an estimated 9,300 eligible Medicaid recipients becoming the first to be enrolled in long-term managed care.

In Miami-Dade and Monroe counties, about 17,000 residents eligible for Medicaid long-term managed care will receive letters in the mail this week informing them of the change and giving them until Dec. 1 to choose one of seven available health plans or have one chosen for them by the state.
Many will be choosing a health plan for the first time as a result of Medicaid reform, which aims to eventually move all of Florida’s estimated 3 million Medicaid recipients into privately-managed health plans with the goal of lowering costs while maintaining or improving the quality of care.

It’s a gigantic experiment, with enormous stakes.

“We don’t know whether or not it can be done any less expensively than it’s being done,’’ said Linda Quick, president of the South Florida Hospital and Healthcare Association, which represents a number of long-term care providers.

In 2011-2012, Florida’s Medicaid recipients cost $20.3 billion, with the federal government paying 56 percent or $11.3 billion and the state picking up 44 percent or about $9 billion.

Medicaid recipients in long-term managed care, including those in nursing homes and assisted living facilities, are among the costliest beneficiaries to care for at an estimated $3.5 billion a year. In 2011, Florida’s legislature made managed care mandatory for nearly all Medicaid patients.
Florida health officials are launching Medicaid reform with the long-term care population, the vast majority of whom are elderly and frail and receive daily living assistance. Disabled adults also participate in the program.

In fall 2014, state officials will begin a second phase of transition by moving the remaining portion of the Medicaid population into managed care plans. Under managed care, private health plans will receive a fixed amount per patient per month to manage a patient’s care. That means previously approved services may be re-assessed and possibly denied as medically unnecessary.

With the new plans, Medicaid recipients receive promises of more coordinated care, while the state hopes to lower its costs, and insurers reap potential profits for agreeing to manage services.

There’s also a question about whether providers will choose to remain in health plan networks at Medicaid rates, which typically are lower than the cost of services.

With a private health plan now administering those dollars, some hospitals and other healthcare providers worry that they will receive even less.

But Cliff Bauer, senior vice president of operations for Miami Jewish Health Systems, said his group has contracted with several local plans and does not expect to receive less.

“We will be paid the same amount by the managed care company that Medicaid paid us prior to the managed care company coming over,’’ he said.

Miami Jewish operates a 462-bed nursing home, and also provides living assistance such as personal care assistance, adult day care, meal delivery and other services to 2,400 people in Miami-Dade and Broward.

About 300 of the nursing home residents receive Medicaid, Bauer said, and no one will be forced to leave.
“It is very clear to me that the state has no intention of forcing anybody out of a nursing home,’’ he said.

Not everyone is convinced, though.

“It’s too early to tell,’’ said Summer, the Georgetown researcher. “There are two motives that people talk about much of the time for the diversion from nursing facilities to the community. One is people really choose that. They really want to live independently. They really believe the quality of their life is going to be better. The other is the financial. It definitely costs less to serve people in the community.’’

To read the entire Miami Herald article, Click Here

In a time when our elderly population is growing and our economy is in trouble, the last thing that we all want to do is  think  about health care reform. The demand for  improved quality of care, the increasing need to cut-costs, and the ability to function with decreased staff numbers plays a large roll  in how we practice medicine today. As health care professionals, we are faced with making sure that we communicate effectively, educate our staff to the fullest potential,  cross train personell, reduce health care related errors, and maintain a high standard of care to our customers.

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