Home > CMS Updates, Health Law Reform -- General, Insurance, Medicaid > Florida Medicaid Managed Care Receives Green Light From HHS

Florida Medicaid Managed Care Receives Green Light From HHS


From Akerman’s Health Law Rx Blog:


Florida has been working on a plan to shift the state’s Medicaid population into managed care for nearly two years – ever since the Florida Legislature directed the change in 2011. On Monday the state received the approval it needed from the federal government.

By letter dated February 1, 2013, the U.S. Department of Health and Human Services granted Florida’s request to waive certain provisions of the Social Security Act, allowing the state to transfer some Medicaid recipients from the traditional fee-for-service program into a Medicaid managed care plan for individuals needing long-term care.

The federal waiver is limited to the state’s Medicaid Long-Term Care Managed Care recipients.  It will allow up to 36,795 Medicaid recipients to receive long-term care services from health maintenance organizations (“HMOs”) or provider services networks (“PSNs”) in the recipient’s local area.  Such a transition would include access to services including adult day health care and case management, instead of more costly nursing home care.  The waiver goes into effect on July 1, 2013, ahead of the state implementation deadline of October 1, 2013.  On January 15, the Florida Agency for Health Care Administration (“AHCA”) posted notices of intent to award Medicaid Long-Term Care Managed Care contracts to PSN American Eldercare and HMOs including UnitedHealthcare of Florida and Sunshine State Health Plan.

A second waiver request is pending with HHS.  If granted, it will allow Florida to shift the majority of remaining fee-for-service Medicaid recipients into the Managed Medical Assistance program via an HMO or PSN in the recipient’s area.  On December 28, 2012, AHCA issued the invitations to negotiate seeking managed care organizations to provide Mandatory Managed Medical Assistance to Medicaid recipients in Florida.  It is anticipated that AHCA will post the notice of intent to award these contracts on September 16, 2013.  If the second waiver request has been granted by this time, the anticipated contract execution date is December 31, 2013.

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