florida medicaid managed care

The second state evaluation (2017) also suffered from a lack of accurate encounter data. Many months later the elderly receiving long term care assistance or in need of such care are among the most vulnerable in the wake of the disaster. Click here to create an account. An important consideration is that nursing home care is considered an “entitlement” while home and community based services are not. Create a FL Medicaid Member Portal account to view or change your plan. For managed care organizations to operate within a capitated rate, there may be a disincentive to provide the full complement of needed serves. Choose to only get letters from Medicaid electronically. Look at the Health Plan and Program Information page to see the Florida Medicaid Managed Medical Assistance core benefits that all plans offer. Click here to report a Medicaid-related complaint. Most Florida Medicaid recipients are enrolled in the SMMC Program. Click here to learn more about Health Plan and Program Information. The report’s own recommendations in Deliverable 16 summarize the need for improved reporting: Page 63, Recommendations: “Improve encounter record reporting. As reported in the “Independent Assessment of the Florida Statewide Medicaid Managed Care Long Term Care Program”, Deliverable 12, MED 186, August 29, 2018: “increasingly higher proportions of LTC enrollees have received services…however, the trend in the level of service use intensity…remains unknown.” Since this type of data is not known, the evaluators used a definition of service utilization as “number/proportion of enrollees for a given service.” A person just has to receive one unit of service in a month to be counted as a service recipient. We are witnessing unprecedented rollbacks in regulations that were established to protect our nation’s Elders. Florida has maintained a cap on home and community based slots at 62,500 annually with CMS approval. Medicaid Managed Care – an eye on Florida and the US, The managed care takeover of states’ Medicaid funded long term care systems has resulted in a general acceptance of the private, for profit, centralized model of care with a goal of moving care into the community and away from nursing homes. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. The cost effectiveness and the quality of services are not really evaluated without the encounter data.”. We can help. © 2020 Florida Agency for Health Care Administration, Plan Non-Emergent Transportation Contacts, Provider Fee Schedules, Rules, and Coverage Policies, 2018-2023 Health & Dental Plan Model Contracts, Administrative Subcontractors and Affiliates Report, Presentations on the 2018 Changes to SMMC. The first evaluation does not reflect any encounter data, so there is no real understanding of quality of services or of the number and/or types of services per capita received. The stated intent was to have better budget control and increased services to the growing boomer population that will double to 84 million by 2050; the 85+ population will triple to 15 million by 2040. Learn More About MMA and LTC Extra service offered by each plan are also listed. The Agency for Health Care Administration is responsible for administering the Statewide Medicaid Managed Care (SMMC) program. Tallahassee, Florida 32306-1124 In fact, the April 19, 2010 St. Pete Times article by Steve Nohlgren was entitled “Florida House Ignores Own Analysts Who Warn of Pushing elderly to Managed Care.” The HMO’s convinced the Florida Legislature and the Governor that they could reduce nursing home admissions and produce a 5% savings by redirecting persons to community based care. Choice Counselors are available at 1-877-711-3662 to answer your questions M-TH 8am-8pm, F 8am-7pm. If you are unable to change Health or Dental Plans online at this time, there are several other options available to you. Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, … Click here to manage your members, view/change your plan, and choose to go paperless! The Florida Agency for Health Care Administration should follow the guidance provided by the Florida State University evaluators in the earlier evaluations of the MMLTC program: 1) to improve encounter record reporting especially on units of services provided; 2) conduct more analyses at the plan and regional levels to understand the differences that impact service capacity; 3) assess what the different plans have done to improve quality of care; 4) improve the health plans reporting on case management for the evaluators have been unable to determine if the problem is with the data reporting or if the case management has been done. Click here to read about the review process. Medicaid is the primary payer for long term care services with Medicare only covering brief stays in long term care hospitals and skilled nursing home facilities. Click here to learn more about Dental Plan and Program Information. (National Governor’s Association, March 2019). The Agency for Health Care Administration is responsible for administering the Statewide Medicaid Managed Care (SMMC) program. For many years Florida key informants reported on the cost effectiveness of the Aging nonprofit network’s home and community based services programs. Florida now has a growing wait list of over 70,000 frail seniors in need of home and community based services. The Agency for Health Care Administration moved quickly in 2012 to build the framework for the managed care takeover. The SMMC program has three components, the Long-Term Care (LTC) program, the Managed Medical Assistance (MMA) program, and the Dental Program. Phone: (850) 644-9311 Arguably the most important, Hurricane Maria devastated Puerto Rico on September 20th and the residents of the island remain in great need of assistance. State and national advocates, as far back as 2010, stressed that the shift to a capitated system of care for a very frail, vulnerable population comes with many potential risks to persons in need of long term care services. The FSU Claude Pepper Center continues to research the literature and collect key informant information around these concerns for access and care quality in the Medicaid LTC program. We will walk you through the process of changing your plan. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. Learn about Health and Dental Plans available in our area. This limitation of encounter data on service intensity continues through to 2020. The managed care takeover of states’ Medicaid funded long term care (LTC) systems has generated several recurring concerns. The multiple evaluations conducted by states such as Florida and those funded by the Centers for Medicaid and Medicare Services (CMS), as well as the recent critique of the Research Triangle Institute’s multi-state evaluations of the dual eligible managed care programs by Community Catalyst, the Commonwealth Foundation and CMS are hindered in their assessments of cost effectiveness by the continued lack of Medicaid encounter data not reported by the managed care companies. A major concern is the lack of consistently reported encounter data on how many people are provided specific services, nor is there good service intensity data provided. Log in to the FL Medicaid Member Portal to change your Health or Dental Plan. A high percentage compared, The June 2018 Dallas Morning News’ investigative series, “Pain and Profit”, published over several days with personal stories as well as a systemic critique of the multi-billion dollar Texas Medicaid, Climate change and global warming are concepts with their fair share of political controversy, but there is no denying the fact that over the past several decades, the average temperature of the earth, Florida State University The managed care takeover of states’ Medicaid funded long term care (LTC) systems has generated several recurring concerns. Would you like to check the status of your Medicaid eligibility? There are three different programs that makeup the Statewide Medicaid Managed Care. The SMMC program has three components, the Long-Term Care (LTC) program, the Managed Medical Assistance (MMA) program, and the Dental Program. In fact, Florida has one of the longest wait lists in the country as the state has successfully ratcheted down the institutional rate in Florida from 54% in 2014 to 43% in 2019. The possibility that incentivized payments could reduce services was a critical underlying concern.