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The National Medicaid Congress Strategies for Navigating the New Medicaid

The National Medicaid Congress Strategies for Navigating the New Medicaid. An Overview of State Medicaid Policy the Executive Branch Prospective Thomas W. Arnold Deputy Secretary for Florida Medicaid. Background Florida Medicaid - Today. $16 Billion. 2.2 Million Beneficiaries.

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The National Medicaid Congress Strategies for Navigating the New Medicaid

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  1. The National Medicaid CongressStrategies for Navigating the New Medicaid An Overview of State Medicaid Policy the Executive Branch Prospective Thomas W. Arnold Deputy Secretary for Florida Medicaid

  2. BackgroundFlorida Medicaid - Today • $16 Billion. • 2.2 Million Beneficiaries. • 80,000 Providers. • 150 million claims per year. • 800,000 HMO/MCO enrollees. • 450,000 Dual Eligibles (Medicaid/Medicare). • 1,000,000 Fee-for-Service Recipients.

  3. BackgroundFlorida Medicaid – Today (continued) • Benefit Plans – One-size-fits-all. • No Incentive for Beneficiary Healthy Behaviors. • Lack of Access to Specialists. • No Incentive for Coordinated Efficient Care Delivery. • Consequence: • Uncoordinated Care. –Overutilization. • Runaway Expenditures. –Fraud. • Compromised Health Outcomes. –“Medicaid Mills.”

  4. Florida Medicaid Reform*1115 Waiver • Consumer Choice: • Managed Care Plans. • Opt Out to Employer Insurance. • Comprehensive and Coordinated System: • Capitated Managed Care. • Fee-for Service Managed Care (reconciled). • Full Risk. • Competitive Marketplace: • Plans Compete for Enrollees. • Empowered Beneficiaries. • Risk Adjusted Rates based on health status. *Details in concurrent session at 11:00am.

  5. Florida Medicaid Reform1115 Waiver (continued) • Defined Contribution. • Improved Access to Care. • Drastically Reduced fraud. • Improved Outcomes.

  6. Medicaid Challenges • Long term Care. • Dual Eligibles. • Specialty Populations: • Disabled. • Chronic Mental Health. • Federal Changes: • Medicare Part D. • Deficit Reduction Act (DRA). • Managed Care. • Oversight. • Funding.

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