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Long-Term Care Transition Bumpy

Florida’s unprecedented transition to managed care for its most fragile Medicaid patients is working, but questions remain about its benefit down the road, according to a report from Georgetown University’s Health Policy Institute released today.

About 40 different individuals involved in the early phases of shifting elderly and disabled Medicaid patients into managed care plans told researchers they are most concerned that more than a third of participants failed to select a plan. Those patients were automatically enrolled in a plan.

"Ultimately you want people to be choosing their plans and seeing which providers are in the network," said Laura Summer, a senior research scholar at Georgetown and author of the report.

Other questions arose about billing and whether state Medicaid officials have too much on their plate, given the 2014 rollout of statewide managed care enrollment for other Medicaid patients -- low-income children, pregnant women, and others who are healthier than those in long term care.

“The transition to a managed care system has the potential to improve quality and decrease costs, but more upfront investment and lead time are needed to achieve the ambitious goals Florida has set for its new program,” Summer said.

Other findings include:

  • Beneficiaries weren’t always notified that they need to select a care plan. Glitches, such as out-of-date addresses and incorrect enrollment timing, were to blame.
  • Enrollment was cumbersome, with multiple calls needed to determine whether those who provide various services -- such as meals and personal care services -- were part of the new managed care plans.
  • Complete plan information wasn’t available in a timely manner on the program website.
  •  Providers are concerned that case managers, now working as employees of a managed care plan, will remain neutral rather than act as advocates for the frail and elderly patients.
  • Staff from the Agency for Health Care Administration has been helpful in terms of the transition, though details about future operation remain cloudy.

So many people in long-term care are incapacitated, said Emma Hemness, a Brandon elder law attorney and member of the Foundation for LTC Solutions advocacy group. Family members or other caregivers need to be proactive in making decisions. Otherwise, the beneficiary could face unintended consequences.  
“If you are an advocate for a senior, you have to watch and you have to watch closely,” she said. “…If a senior chooses a plan and the plan does not have a contract approved with that assisted living facility, it could mean the senior will either have to give up their Medicaid covered services or they have to totally move out of that facility that has been their home.”

Almost 90,000 Floridians are eligible to participate in the state’s long-term care program, which is delivered in nursing homes, assisted living facilities, and at home. The report said 58 percent of beneficiaries lived in nursing homes, and 42 percent were in community-based waiver programs. Another 40,000 were on waiting lists for Medicaid community-based services as of September, the report said.

Four months ago, the state launched the first phase of its long-term care model, approved in 2011 by Florida’s Legislature and authorized earlier this year by federal health administrators. A majority of the funds for Medicaid comes from the federal budget.

Patients in Central and Southwest Florid,a most of the Panhandle and South Florida Counties are now in the managed care program, which is designed to better coordinate care and reduce costs. The remaining regions will roll into the program month by month until March 1.

Summer said survey participants included program administrators, counselors who work with the elderly and disabled, program providers and academic professionals who study long-term care. These initial findings can serve as a lesson for the long-term care program moving forward and for the medical managed care implementation, she said.

"The program is pretty well designed. They put a lot of thought into the transition," she said. "But that's the transition. I think it's going to be important to see what happens after the first year."

Mary Shedden is news director at WUSF.