One of the largest Medicaid managed care expansions has been given the green light for what will be a test of reducing public-payer spending.
The Centers for Medicare & Medicaid Services has approved, under a waiver, Florida's Managed Medical Assistance program, which is transitioning almost all of its 3 million Medicaid beneficiaries to managed care plans that are tasked with comprehensive coverage.
The state legislature devised a statewide managed care expansion program for traditional Medicaid beneficiaries and those receiving long-term care in 2011, and the rollout of both components have been under way last year and this year.
From the Managed Medical Assistance program, covering 3 million Floridians, including many children, state leaders are banking on $2 billion in savings over the life of the waiver, through 2017. Policymakers and patient advocates in Florida and elsewhere will be watching closely to see if the benefits of the privatization come in line with expectations.
"Our staff has worked tirelessly on this approval and we appreciate the federal government cooperating with us to create a managed care system that works best for our state," said Agency for Health Care Administration Secretary Liz Dudek, in a media release.
The Managed Medical Assistance program is relying on three types of Medicaid plans -- HMOs, provider service networks and children's medical services networks -- paid to cover a wide range of inpatient, outpatient and drug benefits.
A number of national and regional health plans are participating in the program -- one of the largest managed care transitions Medicaid has seen -- including WellPoint's Amerigroup, Centene, Humana and UnitedHealthcare, as well as some provider-based plans.
One of the plans with the biggest footprint is run by the Jessie Trice Community Health Center, a federally-qualified health center with 16 facilities. The center's Prestige Health Choice, a for-profit plan that's 40 percent owned by Florida Blue and AmeriHealth Caritas, is covering beneficiaries in eight of the 11 regions.
Three other provider service network Medicaid plans are taking part as well, including First Coast Advantage, a Medicaid plan created by University of Florida Health, and Integral Health Plan, sponsored by Healthcare Network of Southwest Florida and the Association of Area Delivery Systems, a group of FQHCs.
Centene's Sunshine State Medicaid plan is covering beneficiaries in nine regions, WellCare's Staywell in eight, Humana in five, and Amerigroup and United each in four.