managed care

Department of Veteran's Affairs

Far fewer veterans than expected are taking advantage of a new law aimed at making it easier for them to get private health care and avoid the long waits that have plagued Department of Veterans Affairs facilities nationwide.

Only 27,000 veterans have made appointments for private medical care since the VA started mailing out "Choice Cards" in November, the VA said in a report to Congress this month.

The Agency for Health Care Administration will close field offices in West Palm Beach, Alachua and Panama City this summer, as part of the department's increased use of managed care, the News Service of Florida reports. It joins shuttered offices in Tallahassee and Ocala, which closed last year, according to the News Service.

A Third With Medicaid Chose Own Plan

Aug 21, 2014

Only about one-third of Florida’s Medicaid recipients transitioning into managed care statewide chose their own health insurance plans.

Enrollment for the general population started in May and ended in August. Consumers received a letter in the mail two months before enrollment and were given at least 30 days to choose an insurance plan. Those who did not choose a plan were automatically enrolled into a plan by state health officials.

Medicaid Tries HMO for Mentally Ill

Jul 6, 2014

Seeking to improve care and lower costs, Florida this month became the first state to offer a Medicaid health plan designed exclusively for people with serious mental illnesses, such as schizophrenia, major depression or bipolar conditions.

The plan — offered by Avon, Conn.-based Magellan Complete Care — is part of a wave of state experimentation to coordinate physical and mental health care for those enrolled in Medicaid.

Mary Shedden / WUSF

Milagros Medina rents a room in a quiet subdivision on the outskirts of Lakeland. At 68, her arthritis, high blood pressure and chronic back pain are not going away. 

And she doesn’t want to end up in a nursing home.

This retiree who likes being called Miss Millie tries to keep going by getting help with the chores most people take for granted. She says without financial help from Florida’s Medicaid program, she couldn’t afford it. And her health would suffer.

With a billion dollars riding on the contested decision, Florida's Agency for Health Care Administration says it will award its Medicaid managed-care contract for Miami-Dade and Monroe counties to Prestige Health Choice.

The final order, signed by AHCA Secretary Liz Dudek on Friday, rejects a recommendation from an administrative law judge who held hearings in the case in November.  The judge, John Van Laningham, wrote that the corporate structure of Prestige Health Choice did not meet the definition for a "provider service network," or PSN.

Miami-Dade County, the juiciest plum in Florida Medicaid’s switch to mandatory managed care, could still be in play following a ruling against the Agency for Health Care Administration in its contracting decisions. Hundreds of millions of dollars could ride on the outcome. 

The decision by Administrative Law Judge John Van Laningham, issued Jan. 2 tells AHCA that it should rescind its decision to award a contract to Prestige Health Choice for the region that encompasses Dade and Monroe counties.

WellCare Health Plans is forecast to remain No. 1 in Florida Medicaid managed care enrollment next year after winning a challenge to  a state contracting decision affecting patients in northeast Florida.

According to a new report from the Wall Street firm Stifel, Nicolaus & Co., WellCare's enrollment at the completion of  the statewide Medicaid managed-care rollout will likely edge out that of Centene Corp., which does business in Florida as Sunshine State Health Plan.

Tampa-based WellCare Health Plans, Inc. has replaced chief executive officer Alec Cunningham with chairman David Gallitano. 

A report from analyst firm Stifel says Florida has added four more Medicaid managed care contracts in addition to the two insurers, Centene and WellCare, that were awarded contracts in September. 

In October, the state gave contracts to Aetna, Amerigroup, UnitedHealth and Molina.

Even as Florida nursing homes received an above-average score from a consumer group, questions continued to swirl around the departure of three of the leaders of the nursing home ombudsman program who had helped achieve the score. 

The Department of Elder Affairs, where the ombudsman program is housed, came in for sharp criticism in the past six weeks since it initiated an investigation of the ombudsman program's staff and volunteer leaders. The agency fired off a press release late last week defending itself against "an onslaught of negative press."

Florida's statewide Medicaid managed-care gamble gets officially under way on Thursday, beginning with thousands of the state's most vulnerable clients: low-income seniors too sick to get by without help.

If all goes according to plan, taxpayers will save money and frail elders will get preventive and well-coordinated care. They'll have the medical and social support they need to remain in their own homes or in the community, rather than in a nursing home.

Eleven insurance companies responded to the Florida Agency for Healthcare Administration's request for bids to participate in a statewide Medicaid managed care program.  

The federal government has yet to approve Florida’s request for a waiver for the program. As Health News Florida reported, state lawmakers believe it will be approved, based on a letter from Centers for Medicare & Medicaid services.

Workers' compensation consultant Joe Paduda, who has been attending the Prescription Drug Abuse Summit in Orlando, said it's too bad there aren't more comp executives and actuaries there. He writes on his website Managed Care Matters that they need to wake up to the toll that prescription painkillers are taking.

While Florida’s legislative leaders are scornful of Medicaid, some insurers like the profits from their state managed-care contracts, the Tampa Bay Times reports. They’re gearing up to expand next year when the state program goes fully into managed care. And Florida Blue -- the old Blue Cross and Blue Shield of Florida -- is jumping into the game.  

Conservative Republicans in the Florida Legislature declare they despise Medicaid, the state-federal insurance program for the poor. They say they don't want to expand it to cover 1 million uninsured -- even if federal funds pay most of the cost -- because they don't want to put more people in a "broken system."

But they've been describing Florida Medicaid as it stands, with a  fee-for-service payment system that makes fraud too easy and finding a doctor or dentist too hard.

Hospitals, consumer groups and Democrats celebrated Thursday as they recovered from shock over Gov. Rick Scott's change of heart on Medicaid expansion.

Tea Party leaders tweeted moans about betrayal.

Legislators reminded Scott it's not over yet.

Humana, Molina Added to Options for Elderly

Feb 16, 2013

In early February, when the state announced that five companies would be allowed to enroll frail elderly and disabled Medicaid patients in their managed-care plans, Molina Healthcare of Florida Inc. and Humana Medical Plan Inc. weren't on the list.

Federal health officials have given Florida permission to enroll elderly, sick Medicaid patients into private managed-care plans, Gov. Rick Scott’s office announced on Monday.

The three-year waiver of federal Medicaid rules can begin July 1, according to the letter from two officials at the Centers for Medicare and Medicaid Services, part of the federal Department of Health and Human Services.

Associated Press

This is the year that Florida will tackle a raft of controversial and difficult health programs, from the privatization of Medicaid to a debate over how to carry out the Affordable Care Act.