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AHCA Disputes Long-Term Care Story

Florida’s Agency for Health Care Administration has publicly accused Health News Florida of making "inaccurate and incomplete statements" about Medicaid's shift of the elderly and disabled into managed care.

Late Thursday afternoon, AHCA issued a press release that takes issue with an article published on  Wednesday -- Long-Term Care Transition Bumpy -- that summarized conclusions from an issue brief released by Georgetown University Health Policy Institute. The author of the paper, senior Georgetown University researcher Laura Summer, said it was based on a survey of about 40 people who are involved in or know about the ongoing shift of long-term care patients into private managed-care plans.

The AHCA press release did not mention that the Health News Florida article was based on a report by Georgetown University. Instead AHCA said the article "omits facts about recipient choice (and) responsibility in the long-term care program." It then lists a number of "claims" and "facts."

It is Health News Florida policy to correct any errors of fact and clarify anything that may lead to a misunderstanding. However, AHCA did not bring any specific error of reporting to HNF for correction. The "claims" that AHCA objects to appear to be those made by Georgetown University's researcher, Laura Summer, that served as the basis for the HNF article.

The issue brief and article said the long-term care program seems to have been thoughtfully planned and is being implemented with only minor glitches, such as the failure of one-third of the Medicaid patients to select a plan. 

AHCA's press release argues: "The Agency has a robust choice counseling system that allows recipients or their designated representative to learn more about the plans offered in each region and make a plan choice via a call center or in person, or make a selection online any time of day or night.  Choice counseling was also available at hundreds of sessions hosted in various long-term care settings such as skilled nursing facilities, assisted living facilities and adult family care homes. "

The agency said that when it auto-assigns patients into plans it takes into consideration "multiple factors, including an existing relationship with a Medicare Special Needs Plan or Medicare Advantage Plan, known provider relationships" and other matters that are relevant.

The press release continues: "All recipients received at least two letters notifying them of the opportunity to choose a (long-term care) plan.  If a recipient fails to make a choice and their auto-assignment takes effect, the recipient can choose another plan any time during the 90 day period following their enrollment. "

The rollout of the state’s Medicaid long-term care transition to managed care started in Central Florida four months ago. Each month, another region is added.

The Agency said the article didn’t reflect how well the transition is working. AHCA's press release did not mention that the article was based on the Georgetown issue brief.

That report said some of those interviewed had concerns with the agency’s ability to contact beneficiaries so they could select from the available private plans. If a person does not select a specific plan, the state automatically enrolls the person in the most one that most matches their long-term care needs.

The Agency said the number of beneficiaries not being notified by mail was “minuscule.” More so, the state’s counseling system assists beneficiaries in person and via a call center, available “day or night,” the agency said. Hundreds of sessions were held across the state at long-term care facilities, including nursing homes, skilled nursing facilities, assisted living facilities and adult family care homes, AHCA said.

“Plan network information was and remains available to all choice counselors and can be accessed by contacting the Florida Statewide Medicaid Managed Care Hotline and discussing providers and plan network information via the phone or request an in-person meeting,” the agency said. The information also is available online at www.flmedicaidmanagedcare.com  by clicking on the “Enroll Online” button.

The Medicaid transition includes a series of protections aimed at keeping Medicaid recipients connected with their current programs, whether they are at long-term nursing facilities, community-based or services provided at home, AHCA said. And there were no reports of people losing services.

Nearly 90,000 Floridians today participate in Medicaid’s long-term care.  

Concerns the report raised about billing didn’t recognize the agency’s online resources to address questions providers may have, AHCA said. Field offices have been having weekly calls with providers as the transition rolled out and staff provides other services including in-person workshops.

Florida’s legislature in 2011 voted to transition its long-term care and medical Medicaid programs into a managed care system. And the federal government approved the plan earlier this year. Supporters believe that by contracting with private insurance providers, there can be a better coordination of services for beneficiaries and reduce costs.