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Medicaid reform plan participants aren’t spending their healthy behaviors credits

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

06/06/07 © Florida Health News
By practicing “healthy behaviors”, Florida Medicaid reform plan participants can earn up to $125 a year to spend on items such as over-the-counter medications, first aid supplies, vaporizers and blood pressure monitors.

Only they don’t. Most of the $3 million in credits earned in the six months leading up to April 30 remains in the bank, according to the Agency for Health Care Administration.

When AHCA reported the numbers to its Technology Advisory Panel for Medicaid Reform Medicaid on June 1, the leading HMO representative on the panel called for the agency to reduce the money the plans have to set aside for the credits. 

But Medicaid Director Tom Arnold said it was “way too early” to begin tinkering with the estimates or the set aside amount.

While the current 2 percent assessment now paid by the HMOs may exceed the amount of credits now being spent, that could change later on. Medicaid officials don’t want to wind up next year or the year after without enough money to pay for the credits.

Of almost 70,000 Medicaid reform plan members who have earned the credits, fewer than 3,000 had used them as of early May, AHCA’s Chris Osterlund told the advisory panel.

Osterlund said participants have spent just under $65,000 —much of it on children’s medications, such as children’s Motrin and Tylenol.

Participants earn up to $25 in credit for such healthy behaviors as having a child immunized, getting a mammogram and joining a stop-smoking program.

The amount of credits being earned will soon hit $700,000 a month, and Osterlund is hoping Medicaid can entice beneficiaries to start spending those dollars through new marketing activities to begin soon.

Panel member Marc Ryan, vice president of Tampa-based Wellcare, wasn’t convinced plan participants would earn or spend enough credits to equal the $5 to $6 million that could be withheld from payments to the HMOs.

Ryan said HMOs were in process of setting rates and benefits for the coming year. “If 2% is arbitrarily reduced from our cap rate, that reduces the amount going into plan benefits.”

Panel members were reluctant to immediately recommend any changes.

Instead, they asked Ryan to meet with Arnold to review the data and explore possible options. Ryan is to report back to the panel with any recommendations prior to group’s July meeting.

The advisory panel also agreed to monitor the program on a monthly basis to see if credits continue to lag behind the set-aside from the HMOs.

Marketing activities being planned to encourage use of the credits include:

Revamping the list of approved products on the Medicaid website to make it easier for beneficiaries to find what they need and download lists to take with them to the drugstore.

Making pharmacies aware the credits are good for three years after a participant’s eligibility ends so that credits aren’t denied.

Putting Inserts in plan participants’ monthly statements to promote seasonal products, such as cold medicine and nose drops during the winter months.

Identifying people with unused benefits and calling them to encourage them to use their credits.

For more information on the Enhanced Benefits Program, go to: