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The U.S. Department of Health and Human Services has given federal approval to Florida's groundbreaking Medicaid transformation plan. Gov. Jeb Bush said that Florida's reform program will improve quality of care and provide predictability in spending for Medicaid, the state-federal partnership charged with providing healthcare to more than 2.2 million vulnerable, disabled and elderly Floridians.
"This federal approval is recognition of the value of patient choice, coordination of care and the healthy competition spurred by Florida's Medicaid program," said Gov. Bush. "By overhauling Medicaid, Florida is creating a system that empowers patients and expands access to best serve our most vulnerable citizens for years to come."
The state's formal Medicaid waiver application was submitted to the Centers for Medicare and Medicaid Services (CMS) on Oct. 3 for federal approval. As part of Medicaid reform, Senate Bill 838 required the state to secure guaranteed funding from CMS for the Upper Payment Limit (UPL) program. UPL is a mechanism that allows Florida Medicaid to compensate hospitals for care provided to Medicaid and charity patients. In September, Florida reached an agreement on UPL to invest up to $1 billion each year for the next five years. Florida invested $688 million on supplemental payments for hospitals last year.
The first significant overhaul in three decades, Florida's reform plan modernizes an outdated program to better serve participants and bring predictability to state spending. Currently a $15 billion program, the cost of Florida Medicaid could consume nearly 60 percent of the state's budget by 2015 if left unaddressed.
With federal approval, the Florida Legislature will conduct the next review.
Legislative approval of the reform plan will lead to implementation of the first phase in Duval and Broward counties.
Guiding principles of the plan to transform Medicaid include:
MOVING TO A PATIENT-CENTERED SYSTEM
Customized benefit packages will allow health plans to meet the unique needs of participants. With the help of independent choice counselors, participants will be able to select a benefit package that best meets their needs.
Medicaid participants will be able to opt-out of Medicaid entirely and use their State-allocated Medicaid premium to participate in their employer-sponsored health care plan.
Credits for approved health related expenses like over-the-counter medications, smoking cessation classes and other non-covered health services will encourage participants to engage in healthy lifestyle choices, improving health and lowering acute care costs while providing access to health items not covered by Medicaid.
Transparency among plans will be critical in empowering consumers. All plans will be required to collect and report information such as consumer satisfaction, percentage of children who receive annual physicals and preventive dental care, and waiting times for customer assistance, among other measures.
CREATING A MEDICAID MARKETPLACE
Provider groups will have greater flexibility in forming and designing benefit plans that serve the medical needs of enrollees with strict oversight from the state. Providers will attract membership on the basis of their benefit package, innovative care, convenient networks, and optional services. Consumer satisfaction data collected by the State will help participants make informed choices about the plan that best fits their needs.
Each plan will be measured on quality, giving policymakers best practices to continually improve healthcare for Florida's Medicaid participants and help close the gap of minority health disparities.
Market forces will reduce fraud in Medicaid. Because the current Medicaid system pays claims first and identifies fraud later, there is virtually no certain way to control fraud and abuse. Under proposed reforms, health plans have a financial incentive to aggressively guard against fraud. Plans will be required to report overpayments to the State and will be able to identify fraudulent providers within their networks.
For more information about Florida's Medicaid program, visit http://www.myflorida.com or http://www.empoweredcare.com/.
10-24-05
© 2005 North
Country Gazette
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