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Huge Medicaid overhaul request nearly ready

Florida Medicaid officials worked all weekend on a statewide managed-care expansion plan that is due in to the federal government by tonight.

The controversial plan, aimed at reining in the rising costs of the health insurance program for the poor, requires nearly all Medicaid recipients to be enrolled in HMOs or similar managed-care plans. That includes, for the first time, elderly and disabled people who are in nursing homes or headed in that direction.

Shelisha Coleman, spokeswoman for the Agency for Health Care Administration, said many Medicaid staff members, including Deputy Secretary Roberta K. Bradford, worked long hours for weeks to get the request ready for the Centers for Medicare and Medicaid Services. The plan runs to thousands of pages, she said.

The waiver request will be in "by close of business," she said, and will be posted on the AHCA Statewide Medicaid Managed Care Program website by noon on Tuesday.

Even though the Florida Legislature passed the Medicaid overhaul by large margins and Gov. Rick Scott eagerly signed it into law, the state needs a waiver of federal rules in order to proceed and keep federal funding. The federal government shoulders more than half the cost of the program.

Meanwhile, AHCA on Friday requested and received two more weeks to seek extension of the five-county pilot program on which the statewide expansion is based. That letter, signed by Bradford, conveyed unhappiness with news that the states received in a conference call on July 26.

That call shared news that CMS and the Office of Management and Budget were considering an end to a pool of money that has been flowing to hospitals that care for a large number of uninsured patients. It is called the "low-income pool," or LIP.

In the call, CMS officials said LIP funds might end in December 2013. Bradford's letter said the funding is "critical" to Florida hospitals and they had counted on its continuation through June 2014.

"We are disappointed that CMS would choose to make such a material change at the last minute," she wrote.

The reply letter from Victoria Wachino, director of one of the groups that deals with Medicaid at CMS, did not address the LIP funds or Florida's disappointment. It extended the demonstration project through Aug. 14.

As for the statewide managed-care Medicaid overhaul, it drew considerable opposition in public hearings AHCA held around the state, especially from elder-law attorneys protesting Medicaid's plan to include low-income seniors in nursing homes and to have them enrolled first, starting in the fall of 2013.

In mid-July, four of the Legislature's highest-ranking Democrats on health committees sent a letter to the Obama administration, asking that it not approve the waiver request.

That was followed by a letter making a similar request from 100 patient-advocacy groups, including several medical societies around the state.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.