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State Cracks Down on Medicaid Marketing

Agency for Health Care Administration

Florida has banned health insurance companies from marketing their plans directly to Medicaid recipients as the state rolls out its massive plan to privatize its health insurance program for low-income individuals and the disabled.

Private companies that have contracted with the state to provide care for Medicaid patients are allowed to market to consumers with prior state approval. However, the Agency for Health Care Administration said marketing events are currently banned because officials want to focus on enrollment and making sure patients don't experience lapses in care during the transition.

"Significant resources are needed to ensure responsible implementation," spokeswoman Shelisha Coleman said Friday.

Enrollment into the new Medicaid program started in May and ends in August for the general population.

The long-term care population, which includes those 65 and older who reside in nursing homes, has already completed enrollment.

Under Medicaid privatization, the state gives insurance companies a set amount of money each month (between $300 and $428 a month for a woman between 14 and 54 years old) to care for more than 3 million patients — more than half are children. Insurers have broad authority to determine patient care, including which doctors they can see and what treatments can be prescribed.

Consumers can choose among the insurance companies that have contracts with the state.

State health officials have approved some advertising, including billboards and radio ads, but marketing at events like health fairs or any interaction where insurers are talking directly with consumers is forbidden for now.

The state is trying to avoid problems from the past, when aggressive marketing agents for insurance companies went to patients' homes and cornered them in parking lots at doctor's offices, tricking them into signing forms switching them into a different health plan, or falsifying documents.

Marketing Medicaid HMO coverage door-to-door was prohibited in Florida in 1995 after regulators saw people were enrolling in plans they didn't understand.

"Banning direct to consumer marketing is a smart idea in a state that has had many problems in the past ... an outright ban will protect consumers more effectively as plans may seek to cherry pick customers this way," said Joan Alker, executive director of Georgetown University's Center for Children and Families.