Medicaid managed care

The state starts rolling out new Medicaid managed care plans on Saturday and some are worried about the impacts to Florida’s most vulnerable children.

Medicaid Plans Show Losses In First Half Of Year

Nov 2, 2018
iStock

As many as half of the managed-care plans providing Medicaid services to Floridians were losing money midway through the year. But key players say they are not worried.

Agency for Health Care Administration Secretary Justin Senior is meeting with 12 managed-care companies that filed petitions with the state last week, as he tries to dissuade them from legal fights over the state’s decisions to award five-year Medicaid contracts that could be worth up to $90 billion.

Magellan Health intends to protest an Agency for Health Care Administration decision to shut the health plan out of the state’s Medicaid managed-care market.

Wikimedia Commons

Managed care organizations that want to challenge the award of upward of $90 billion in Medicaid contracts to nine health plans across the state have until late Friday afternoon to launch protests. 

Senate Panel Digs Into Medicaid Long-Term Care

Dec 15, 2016

With a major nursing-home group looking for changes, a Senate panel Wednesday began delving into part of the Medicaid program that involves seniors enrolling in managed-care plans.

Georgetown University

Since 2014, Florida’s Medicaid program has been run not by the state but through private insurance companies. The Sarasota Herald-Tribune has written about problems with the managed care system and a recent report from Georgetown University surveyed pediatricians to determine how they feel about the system.

A decade ago, a group of providers sued the state, charging Florida’s Medicaid program shortchanged medical and dental care for kids. Proponents said Medicaid Managed Care was supposed to make it better, but five years into the new system, the legislature is poised to remove dental coverage for kids and roll it into a separate program.

Albuminarium

Used to be, Marianne Power could sit down one night, do all of her own billing and get paid 10 days later. That was before Florida hired private insurance companies to manage its Medicaid program in 2014.

A screening system for the state's Children's Medical Services program has resulted in the removal of 9,000 poor and disabled children from the program, the Miami Herald reports.

New Panel Eyes Changes To Children's Medical Services

Nov 2, 2015
Wikimedia Commons

State Department of Health officials Friday hosted the first meeting of a panel aimed at easing Florida's transition to Medicaid managed care for children who need specialized medical services.

Wikimedia Commons

Florida is one of only three states where county public health departments employ obstetricians for pregnant women.

It’s a legacy of the 1990s, when Florida’s infant mortality rate was one of the worst in the nation. But this safety net is eroding.

Simply Healthcare

Leadership changes have been announced for two Florida Medicaid plans that are merging. 

Amerigroup Florida and Simply Healthcare Plans announced in a statement that Lourdes Rivas, the CEO of Simply Healthcare, will be the Florida Medicaid plan president for the new consolidated operations. Amerigroup Florida president and CEO Rosy Cozad, will take a new post within the organization.

Judge Rules Against State In Dispute Over Children's Medical Program

Sep 23, 2015
Stethoscope and gavel against a white backdrop.
Wikimedia Commons

An administrative law judge Tuesday ruled against the Florida Department of Health in a challenge involving the eligibility of children for a state program that provides specialized medical care.

Judge Deciding Special-Needs Children Dispute

Aug 26, 2015
U.S. Army

An administrative law judge is considering a challenge to the Florida Department of Health involving the eligibility of children for a state program that provides specialized medical care.

Medicaid health plans, which lost $543 million in the first half-year of Florida’s Statewide Medicaid Managed Care program, have been hoping for major rate relief Sept. 1, when the second year of the program begins.

The Agency for Health Care Administration has proposed a rate increase averaging 6.4 percent for the coming year, ranging from less than 1 percent in the Pasco-Pinellas Counties region to 14 percent in two north Florida regions that cover rural counties.

House Panel Blocks Medicaid Dental Changes

Mar 11, 2015
Child receiving a mouth exam
Dave Buchwald

A House panel Tuesday rejected a proposal to revamp the Medicaid program's system of providing dental services to children.

The House Health Innovation Subcommittee deadlocked 6-6 on the proposal (HB 601), filed by Rep. MaryLynn Magar, R-Tequesta. A tie kills a bill. 

Under the state's new Medicaid managed-care system, HMOs and other types of managed-care plans are responsible for providing dental services to children.

WellCare Profits Drop, Blames the Flu

Feb 12, 2015
WellCare Health Plans

WellCare Health Plans, a major player in Florida's Medicaid system, saw lower profits during the fourth quarter of 2014 and pointed to the heavy flu season as a cause.

The Tampa-based company reported Wednesday that net income during the fourth quarter was $7.7 million, or 18 cents per diluted share, down from $42.9 million, or 97 cents per diluted share, during the same period in 2013. On an adjusted basis, net income during the final quarter of 2014 was $18 million, or 41 cents per diluted share, compared with $48.2 million, or $1.09 per diluted share, during 2013.

Anthem Inc. will take over South Florida's Simply Healthcare Holdings, which manages polices for about 170,000 people with Medicaid and 22,000 people in Medicare, the News Service of Florida reports.

State agencies wanting to introduce new evidence into a nine-year-old fight over Florida Medicaid is being criticized by children’s advocates, the News Service of Florida reports. The lawsuit led by the Florida Pediatric Society claims the state does not provide adequate care for kids in the Medicaid program. The Agency for Health Care Administration and Florida Department of Health filed documents asking that the state’s new managed care system should be considered, according to the News Service.

Private Companies Shouldn't Run Medicaid

Oct 7, 2014

In reference to: "Despite Progress, Problems—New And Old—Pop Up In Florida's Medicaid Managed Care Program," Health News Florida, Sept. 15, 2014

To the Editor,

Like many other states, Florida has shifted the administration of its Medicaid into a program administered by the private insurance industry. 

Florida recently finished rolling out a new way of providing care to more than 3.5 million low-income Floridians. Nearly all of them are now enrolled in managed care plans. The state agency that runs Medicaid recently released a series of comments from various players in the industry praising the rollout. But some groups say the new system is still plagued with problems.

Agency for Health Care Administration

It’s much too soon to say whether this summer’s flood of Florida Medicaid patients into private managed-care plans will accomplish the state’s goals of improving access to care and saving money.

But one result is already clear: The overhaul is concentrating power in the hands of specialty companies over which the state has no direct control.  Some say one such company has essentially taken over home care services and equipment.

A Third With Medicaid Chose Own Plan

Aug 21, 2014

Only about one-third of Florida’s Medicaid recipients transitioning into managed care statewide chose their own health insurance plans.

Enrollment for the general population started in May and ended in August. Consumers received a letter in the mail two months before enrollment and were given at least 30 days to choose an insurance plan. Those who did not choose a plan were automatically enrolled into a plan by state health officials.

WellCare sign denoting building
WellCare

WellCare Health Plans, Inc. saw its stock price plunge more than 20 percent at one point on Friday after announcing its second-quarter net loss of $7.5 million, due mainly to high medical expenses in connection with the expensive rollout of Florida Medicaid's statewide managed care program.

The expansion of Medicaid managed care is the reason for the elimination of 85 state jobs at the Florida Department of Health in Polk County, the Lakeland Ledger reports. Among the positions that will be eliminated are registered nurses, advanced registered nurse practitioners, licensed practical nurses and health support workers. According to the Ledger, 28 of the positions are vacant.   

State Cracks Down on Medicaid Marketing

Jul 22, 2014

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.

Adriana DeJesus

Adriana DeJesus doesn't remember getting a letter.

Her kids - 6-year-old Angel, and son, Christian – have been covered by Medicaid plans since birth. Her son’s asthma and ADHD keep her regularly connected to his doctors and make her diligent about understanding his health coverage.

But the St.Petersburg daycare worker says she missed seeing a notice that Florida is moving 3.5 million residents in its medical insurance program for the poor to a new managed care system.

Wikimedia Commons

It’s May 1, and a host of counties are now part of a new Florida Medicaid program that includes almost all recipients. That has led to a lot of confusion, starting with transportation.

Behind-the-scenes negotiations between insurers are powering Florida Medicaid’s transition to statewide managed care plans, the Naples Daily News reports (paywall alert).

The Agency for Health Care Administration last year awarded contracts to 17 companies in 11 regions across Florida. That prompted 64 different legal challenges from insurers that stood to lose out on a share of an estimated $80-billion pie.  

Pages