Floridas Medicaid Reform Proposal

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Floridas Medicaid Reform Proposal
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Kay M. Mitchell, MD, FACP

• Assistant Professor of Medicine, Mayo School of
  Medicine

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• Florida Medicaid system, created in 1970 has
  operated in a governmental centralized fashion
• The 30 year old system has not undergone systemic
  reform since its inception

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• Florida Medicaid serves 2.2 million patients and
  with reform will recognize the patients role in
  planning and purchasing healthcare services.
• Reform will assure access to quality service and
  provide stability to the state budget.

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• Currently the program expense has increased by
  13 per year, includes 47 different services on
  fee for service, 11 contracutal HMOs, includes
  primary care case management programs, mental
  health and dental services.

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• The result of these many services and others not
  listed is a large, complex system that is hard to
  naviagte and more difficult for the state to
  manage.
• Fraud, which is almost exclusively in fee for
  service will be lowered by new premium based
  service.

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• The prinicples of Medicaid reform are
• Patient responsibility and Emowerment
• Marketplace Decisions
• Bridging Public and Private Coverage
• Sustainable Growth Rate

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• Empowered Care Embraces
• Risk-adjusted premiums for Medicaid eligible with
  comprehensive care, catastrophic care, and
  enhanced benefit account

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• Employer-Sponsored Insurance will allow
  individuals to use premiums to opt out of
  Medicaid.
• Safety Net Fund will be established and
  maintained by the state to safety net providers
  who meet certain requirements

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• To begin the reform, Florida will submit an 115
  Research and Demonstration waiver
• Eligibilty and enrollment will use existing
  processes
• The state will establish premiums based on
  historical utilization of the mandatory and
  optional services

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Delivery Systems

• Managed care organizations including HMOs and
  EPOs
• Lisensed insurers including PPOs and POS
• State Certified Contractors
• Employer_sponsored insurance

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Implementation

• There will by 4 phases over 5 years
• Initial area of implementation is Medicaid area 4
  which includes my county Duval.
• The state will procure the final plans, create
  evaluation teams to review and approve the plan
  applications, evaluate the eligibilty and
  enrollment processes and create an outreach and
  education team to focus on development of
  strategies.
• Payment team to develop premiums.

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• The entire state should be covered by 2011.
• Accountability and monitoring will be by ACHA
  (Agency for Healthcare Administration)