Transcript Medicaid Presentation

Statewide Medicaid Managed
Care Update
Beth Kidder
Assistant Deputy Secretary
for Medicaid Operations
Presented to the Florida Commission for the
Transportation Disadvantaged
February 3, 2012
Overview of 2011 Legislation
• In 2011, the Florida Legislature created Part IV of Chapter
409, Florida Statutes, which directed the Agency to
implement the Statewide Medicaid Managed Care program.
• The Statewide Medicaid Managed Care program has two
key program components:
– the Long-term Care Managed Care program
– the Managed Medical Assistance program
• All Medicaid recipients are required to enroll in a managed
care plan unless specifically exempted in the legislation.
• Certain recipients are required to enroll in the Long-term
Care Managed Care Managed Care program.
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Why Change the Program?
• The goals of Statewide Medicaid Managed Care program
are:
– patient centered care, personal responsibility and active
patient participation
– provide for fully integrated care through alternative
delivery models with access to providers and services
through a uniform statewide program
– implement innovations in reimbursement, quality and
increased plan accountability.
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Status of SMMC Implementation
• Federal authority has been requested to implement key
provisions
• Communication with federal CMS has begun to negotiate
program approval
• Project management and team structure implemented
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Federal Authority Requested
• Seeking amendment of the 1115 Medicaid Reform
Demonstration Waiver:
– To mandatorily enroll most Medicaid recipients in Statewide
Medicaid Managed Care plans
– To allow health plans to develop customized benefits
packages
– To implement the SMMC on a statewide basis
– To impose additional premiums and co-payments as
required under the SMMC program
• Agency has received informal questions from CMS regarding
Amendment #1 (statewide expansion) and is in the process of
preparing a response.
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Federal Authority Requested
• Seeking a new 1915 (b)(c) waiver to implement the LongTerm Care component of the SMMC program
– To identify and allow qualified individuals to receive home
and community based care services in lieu of nursing home
care services.
– To enroll individuals in managed care plans statewide, and
to allow for selective contracting of those plans.
• The Agency has responded to formal requests for additional
information on both the 1915(b) and (c) portions of the
waiver.
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Project Phases
• Design
– Setting foundations
– Submitting applications (waivers, concepts, state
plan amendments)
• Pre-Implementation
– MCO Solicitation
– Contract Execution
• Implementation
– Outreach and Enrollment
• Post Implementation
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Next Steps
• Continue negotiation with Federal CMS for
program approval
• Finalize program development, drafting of
procurement and contract documents
• Continue assessment of Agency organization and
potential re-alignment for management of the
SMMC program
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How to find information about
program changes
• Please visit the Agency’s website for:
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the status of the waiver to federal CMS
the implementation timeline
the progress of the negotiation and contracting with plans
information for providers and recipients about implementation and plan
enrollment as it becomes available.
• Go to www.ahca.myflorida.com and click
the left, below the picture of the Secretary.
on
– Sign up to receive e-mail updates via the website.
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Questions?