Medicaid Changes Raises Questions About Impact on Floridians

The latest in a series of policy briefs focused on proposed changes to Florida’s Medicaid program—presented to more than 30 stakeholders and political leaders in Tallahassee on January 18 and then to another 200 through a webinar on January 19—raises many questions about the proposal’s impact on Floridians who receive long-term care.

Florida’s proposed new Long-Term Care Managed Care program, which will cover adults 65 and older and younger adults with disabilities, will affect as many as 84,000 current Florida Medicaid beneficiaries as well as another 27,000 eligible individuals who are on various waiting lists for services.

The new briefing paper — Proposed Medicaid Long-Term Care Changes Raise Host of Questions About Impact — is from researchers at Georgetown University’s Health Policy Institute. The educational brief is one of a series commissioned by the Jessie Ball duPont Fund and the Winter Park Health Foundation. Two earlier briefs were released in December 2011.

In Tallahassee, participants heard from keynote speaker Laura Summer, Senior Research Scholar, Georgetown University’s Health Policy Institute, as well as a panel of industry experts including Beth Kidder, Assistant Deputy Secretary for Medicaid Operations, Agency for Health Care Administration; Jack McRay, Advocacy Manager, AARP Florida; Teresa Barton, CEO, Aging True; and Tony Marshall, Senior Director of Reimbursement, Florida Health Care Association.

Lisa Portelli, WPHF Program Director, Community Health, served as moderator.

In the brief, the authors cite questions arising about:

• The timeline and resources allocated for implementation of the proposed new program;
• The structure of the new  program, which has beneficiaries required to enroll in two different programs;
• The services to be provided to help beneficiaries transition to the new program;
• The feasibility of shifting patients from institutional to community-based care settings;
• The impact on program costs;
• The impact on quality of care.

“In order to better understand what the implications of the changes will be for service delivery and program costs, more detail is needed, particularly about who will have access to community-based services, how transitions and service coordination will be achieved, and how the adequacy and quality of services will be assured,” the authors write.

The Tallahassee forum participants expressed many concerns about the concept including:

• The “long-term-care” population, the elderly and disabled who require routine care, assistance with daily living and frequent medical treatment, are scheduled to be the first of the state’s three million Medicaid recipients to move into managed care.   AARP representatives expressed concern that this very vulnerable group will pave the way into the new system and the result could be that care is not well coordinated between existing and new medical providers.
• The aggressive timeline that may not assure a smooth transition. The state is to begin enrolling the 84,000 eligible persons in January 2013 and there are many unanswered questions and issues to work out before that date.
• The state has a long waiting list (27,000) for home and community-based services and there are no state funds to address it. Patients on a waiting list may have to reside in nursing homes if there is a shortage of support services for those at home or in assisted living.
• The program has “significant design flaws” that ignore both the real costs of the conversion and the aging population bomb.
• The pilot programs have not proven that the ultimate goal of cost savings can be reached.

AHCA representatives advised the group to take concerns to the Technical Advisory Work Group which was created by the Florida Legislature last year to address the numerous concerns expressed by advocates, providers and health plan representatives.

Copies of this brief, as well as the earlier briefs, may be found at www.wphf.org and at http://hpi.georgetown.edu/floridamedicaid/ .