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Medicaid Managed Care Rates Tweaked

Stethoscope on a pile of money.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

State economists on Tuesday agreed to increase payment rates for Medicaid HMOs that treat women and children by an average of 0.2 percent but decrease the amounts paid to long-term managed care plans by an average 0f 2.3 percent. 

The changes would be some of the smallest adjustments over prior-year payment rates since the statewide Medicaid managed-care program was fully launched in 2013. Health plans and provider networks that participate in Medicaid managed care are paid what are known as capitation rates for patients who enroll in their plans.

The plan gets paid the same rate regardless of the amount of care an enrollee receives. Federal law requires that rates be actuarially sound. The new rates were presented Tuesday to members of the Social Services Estimating Conference by actuaries from the Milliman actuarial and consulting firm.

Tom Wallace, an assistant deputy secretary for Medicaid finance and data analytics at the state Agency for Health Care Administration, said the state has not finalized rates for Medicaid dental plans.

Florida in 2017 started the lengthy process of renegotiating five-year Medicaid managed-care contracts, which were signed with health plans last year.