Filed Under:Agent Broker, Agency Management

Major Changes Ahead for Medicaid

During its 2011 session the Florida Legislature passed HB 7107, considered to be a landmark Medicaid reform act that will convert Florida’s Medicaid system from a traditional fee-for-service (FFS) system to one primarily based upon managed care plans. Once overhauled, Florida’s system will be one of the only Medicaid programs in the nation to operate under a managed care system.

According to the Florida Agency for Health Care Administration (AHCA), Florida’s current Medicaid enrollment is approximately 2.97 million people, half of whom are children or adolescents under the age of 20. More than 100,000 Florida medical facilities and medical professionals offer services to Medicaid enrollees. To become eligible to provide services to Medicaid recipients under Florida’s current system, a medical provider need only complete an online application at AHCA’s fiscal agent website.

AHCA has been given general guidelines by the Legislature for the plan selection criteria. For plans seeking to participate in the Medicaid-managed medical assistance program, this includes accreditation, network availability, community partnerships, disease management, policies and procedures for preventing fraud and abuse, and prior business relationships within the applicable region. 

Selection criteria for plans seeking to participate in the long-term care managed care program include executive managers with expertise and experience in serving the aged and disabled, establishment of specialty services for persons receiving home and community-based care, whether the eligible plan has a contract to provide managed medical assistance services in the same region, whether a plan offers consumer-directed care services to enrollees, and whether a plan is proposing to provide home and community-based services, in addition to the minimum required benefits. Preference will be given to plans with well-defined programs for recognizing patient-centered medical homes and state-based entities. 

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