On August 1, 2011, Florida’s Agency for Health Care Administration (AHCA) submitted an application to the federal government’s Center for Medicare & Medicaid Services (CMS) requesting a waiver of federal Medicaid rules for the state. This waiver requested that Florida be allowed to require all Florida Medicaid recipients to enroll in a managed care organization. The waiver request suspends many federal requirements in favor of Florida’s managed care proposal.
On February 1, 2013, CMS granted Florida’s waiver request to require all Medicaid recipients to enroll in a managed care organization in order to receive Medicaid benefits. The first group of Medicaid recipients required to enroll in managed care are those needing Medicaid long term care such as a nursing home. This waiver is referred to as Florida’s Statewide Medicaid Managed Care Long Term Program (SMMCLTC).
The program is being rolled out across Florida in stages. The state is divided into eleven regions. Each region is covered by at least two managed care organizations who will provide long term care services to Medicaid recipients through a provider network. SMMCLTC will be implemented at a different time of year in each region to allow managed care organizations to establish a provider network, and ready the state to provide care for nearly 85,000 elderly individuals. For an explanation of basic managed care principles, see my Elder Law Issues blog “What is Managed Care or a Managed Care Plan?” posted last week.
AHCA will notify Medicaid recipients who need nursing home care when they must enroll in a managed care organization in their region and what managed care choices are available. To find out which region you or your loved one are in, see the map available through AHCA’s website. To see when AHCA should notify you to enroll in a managed care organization, see the timetable available through AHCA’s website. To see which managed care organizations are available in your region and what services they provide, enter your county or zip code in the search feature available here.
As part of my involvement with the Academy of Florida Elder Law Attorneys and the Florida Bar’s Elder Law Section, I was one of a few elder law attorneys in the trenches, advocating for Florida’s seniors, while Medicaid Reform was taking shape. My main concern is that seniors receive quality care and that managed care companies put that ahead of profits. Do you have the same concerns about your transition to managed care? I encourage you to post your concerns right here and let me hear your voice! We must make sure that you are protected with the right doctors and prescriptions, and receive the health care that you have earned.