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Rollout Posted for Frail Elderly to Enter HMOs

The region that includes Orlando and Melbourne will be the first in the state to enroll its frail elderly patients who are on Medicaid into managed-care plans, the Agency for Health Care Administration announced Monday.

A map on AHCA's website offers a guide as to which counties are included in the rollout, which hinges on approval by the U.S. Department of Health and Human Services for Florida's requests for a waiver of federal law for its Statewide Medicaid Managed Care program. 

Florida's intention is to enroll all 3.3 million Medicaid patients into HMOs or similar tight-network plans, except those with developmental disabilities such as autism or Down syndrome. The Legislature passed the plan in 2011, but Florida is still waiting for the waiver approval.

After Florida Gov. Rick Scott met with HHS Secretary Kathleen Sebelius last week, he said he had asked that the waiver be expedited. For her part, Sebelius pushed Florida to accept federal funds to expand the Medicaid program to about 1 million of the state's uninsured.

Some patient advocates have questioned whether the elderly and disabled who qualify for long-term-care are going to be in a position to choose the best plan for them and to ensure their needs are met. On the other hand, supporters of Medicaid managed-care for frail elders say plans only profit if they keep these patients healthy and out of nursing homes.

Two-thirds of Florida's Medicaid recipients are already enrolled in managed care plans, but they tend to be children, pregnant women and others who are usually on the healthy end of the spectrum. Those who haven't joined networks will be enrolled over the next two years, assuming the waiver comes through.

The frail elderly and disabled -- those who qualify for and really need assistance to avoid nursing homes -- will be the first of two groups to be absorbed into the managed-care system. Legislators said they needed to go first because they are the most expensive, and the state was looking for savings.

According to AHCA's notice, the rollout schedule includes dates on which documents are due to the agency from the plans, deadline for enrollment and launch dates. The first group of long-term-care patients will be covered by the plans as of Aug. 1, with other regions coming on line through March 2014.

The regions' launch dates are:

--Aug. 1, 2013 for Region 7 -- Orange, Seminole, Osceola and Brevard counties.

--Sept. 1, 2013 for Regions 8 and 9 -- Southwest Florida and Treasure Coast.

--Nov. 1, 2013 for Regions 1, 2 and 10 -- Broward County and northwest Florida including  Pensacola and Tallahassee.

--Dec. 1, 2013 for Region 11, Miami-Dade County.

--Feb. 1, 2014 for Regions 5 and 6, Tampa Bay.

--March 1, 2014 for Regions 3 and 4, north-central and northeast Florida, including Gainesville and Jacksonville.

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.