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.
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.
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, theTampa 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.
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.