With the Senate scheduled Monday to consider a Medicaid-overhaul bill, top senators are still trying to work out a deal with the House.
Last Thursday, federal health officials sent a message: Approval of a statewide managed-care program likely won’t be fast or simple.
The federal Centers for Medicare & Medicaid Services said Florida will not receive the go-ahead for statewide managed care as part of its renewal of a five-county Medicaid pilot program.
Instead, Florida will have to submit a new statewide proposal that addresses myriad issues, including steps to guarantee that Medicaid beneficiaries will receive quality care, according to a letter sent to the Agency for Health Care Administration.
“Such a plan will need to ensure that access to and quality of health care is ensured,” wrote Richard Jensen, director of the Centers for Medicare & Medicaid Services’ (CMS) Division of State Demonstrations and Waivers. “In Florida, this has been a constant theme shared by beneficiaries, health-care providers, advocates and oversight entities since the implementation of the Florida Reform Demonstration (pilot program).”
Jensen’s letter came in response to AHCA Secretary Elizabeth Dudek notifying the federal government last month that Florida planned to expand managed care statewide. Dudek said such an expansion could be done under the federal “waiver” that created the pilot program.
Florida legislative leaders have said for months they want to transform Medicaid into a statewide managed-care system, arguing that such a move could help hold down future costs in the $20 billion program.
But with a week left in the legislative session, the House and Senate have not agreed on an overhaul bill. The House has approved its version, and the Senate is expected to take up its bill Saturday.
Ultimately, the two chambers will have to agree on a final plan. The CMS letter Thursday said that without legislation passing, “we have no specifics from Florida about what it may be planning with regard to statewide implementation of managed care.”
House Speaker Dean Cannon, a Winter Park Republican who has played a key role in the Medicaid issue, said he was not surprised at the federal agency’s stance.
“That’s to be expected,” Cannon told reporters. “For CMS to issue a waiver, they’ve got to have something specific that we’re asking for them to waive.”
The House proposal calls for gradually moving almost all Medicaid beneficiaries into managed-care plans over five years.
But the Senate wants to move much faster, even threatening to pull out of the federal program if approval doesn’t come by the end of this year. Such a move likely would lead to forfeiting billions of dollars in federal aid.
Florida began the controversial pilot program in 2006 to require Medicaid beneficiaries to enroll in managed-care plans. The pilot operates in Broward, Duval, Baker, Clay and Nassau counties.
The pilot expires June 30, which has forced the state to seek a renewal that remains pending. Meanwhile, lawmakers and AHCA officials have been embroiled in the bigger-picture debate about taking managed care statewide.
Thursday’s letter does not indicate how long the approval process might take after CMS receives a statewide proposal. But it includes a list of complicated issues that the state will have to address.
Lawmakers have been discussing many of the issues on the list, such as a detailed expansion schedule and a process to select the managed-care plans that would get contracts.
Also, CMS indicated it would require the state to use a so-called “medical loss ratio,” which is a calculation that ensures managed-care plans spend enough money on serving beneficiaries. Lawmakers have grappled with whether to include such a ratio in their bills.
By Jim Saunders
