Medicaid Transformation Watched Closely In Florida

Medicaid Transformation Watched Closely In Florida

This week the federal government signed off on the first part of a plan that could eventually steer more than 3 million low-income Floridians on Medicaid into a managed care, or HMO system. The decision comes two years after Florida lawmakers approved the conversion in an attempt to control costs in the $21 billion program.

At that time, retirees were skeptical of how it would work.

“For-profit companies have a fiduciary responsibility to do what? Make money. So they’re not going to manage their care, they’re going to ration their care,” said Joseph Flynn, a retiree living in the Central Florida community of the Villages, where Gov. Rick Scott was holding a budget signing ceremony.

That skepticism has not gone away but now the federal Centers for Medicaid & Medicare Services has signed off on part of a waiver allowing Florida to begin its transition to managed care for Medicaid recipients in long-term care.

Under the state’s current fee-for-service model, when the patient goes to a nursing home, hospital or doctor, the health provider bills the state, and the state cuts a check. But that system is expensive, difficult for frail patients to navigate and doesn’t necessarily result in good care. Florida officials and industry representatives say managed care will be an improvement.