Florida’s Medicaid Overhaul Drops Patient Counseling

When Florida lawmakers approved a Medicaid overhaul last month, they decided almost all beneficiaries should enroll in HMOs or other types of managed-care plans.

But more quietly, lawmakers also rejected a program aimed at helping beneficiaries navigate the managed-care system.

The overhaul does not include continuing to use a “choice counseling” program to provide information to beneficiaries about the plans available to them. The state has spent millions of dollars in recent years to pay companies to act as advisors for beneficiaries who have enrolled in managed care.

Senate Health and Human Service Appropriations Chairman Joe Negron, R-Stuart, said Tuesday that Medicaid beneficiaries are capable of choosing health plans without needing a choice counselor to help them with the details.

“I don’t believe Medicaid recipients need a retinue of intermediaries to make informed decisions,” said Negron, one of the chief architects of the Medicaid changes.

But critics said they think the federal government, which must sign off on the Medicaid overhaul, will require a choice-counseling program. The state Agency for Health Care Administration faces an Aug. 1 deadline for submitting a detailed proposal to the federal Centers for Medicare & Medicaid Services.

Without choice counseling, Florida Legal Services attorney Anne Swerlick said many beneficiaries would wind up not choosing any managed-care plan. When that happens, the state would make the enrollment decisions for them.

“People are going to end up being assigned to plans that they don’t want to be in” and will have “no idea how to access services,’’ said Swerlick, who closely follows Medicaid issues.

The overhaul, which is spread across two bills, will require almost all Medicaid beneficiaries to enroll in HMOs or other types of managed-care plans by October 2014.

By Jim Saunders