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Florida Medicaid Update

Florida Medicaid Update. Challenges in Medicaid and Opportunities through the Affordable Care Act. Laura Goodhue Executive Director Florida CHAIN February 3, 2012 . Florida’s Uninsured and Low-income Health Consumers. 4 million uninsured. 507,000 are kids. Medicaid recipients are:

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Florida Medicaid Update

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  1. Florida Medicaid Update Challenges in Medicaid and Opportunities through the Affordable Care Act Laura GoodhueExecutive DirectorFlorida CHAINFebruary 3, 2012

  2. Florida’s Uninsured and Low-income Health Consumers • 4 million uninsured. 507,000 are kids • Medicaid recipients are: • Very poor children, pregnant women, seniors, and persons with disabilities 3 million Medicaid recipients from 2 million in 2006

  3. Medicaid (Direct) Cut Options: A Familiar List

  4. Medicaid Coverage Today (FY 2010-11)

  5. The Patient Protection and Affordable Care Act protects Medicaid now from further cuts Without this “Maintenance of Effort” protection we could expect:

  6. Step 1: End Eligibility for “Optional” Patients

  7. Step 2: Eliminate Coverage of “Optional” Benefits

  8. Step 3: Squeeze Payments to Providers (AGAIN)

  9. Florida House Budget Proposal 1.31.12Total “savings”: $10M in General Revenue (about one-tenth of 1%) * Physician Services is a Medicaid mandatory service. Even if the Legislature seeks to make cuts, benefit limits must be set at a level that meets the preponderance of recipients’ needs. This change could not meet that standard. ** Under the Affordable Care Act, Florida cannot tighten Medicaid eligibility criteria, directly or indirectly.

  10. INDIRECT CUTS:Maximizing the Reach of HMO-Style Managed Care At Least 4 Levels in Play:1. Eliminating Access to MediPass/Fee-for-Service2. Medicaid Reform3. Statewide Medicaid Managed Care 4. Total Cap on Program Spending

  11. Medicaid Reform Pilot: Stats Waiver of many otherwise applicable Medicaid laws and requirements Initially 5 years (2006-11) 3-year extension pending but imminent (2011-14) 5 counties (had been expected to expand statewide) Mandatory participants: Children & families related SSI-related HMOs and Provider Service Networks

  12. Medicaid Reform Pilot: Features • Elimination of MediPass . Required enrollment in managed care plan • Plans have unprecedented flexibility, allowed to vary: • Amount, duration and scope of benefits • Preferred Drug Lists • Many other aspects of their operation • Number of other components that have not worked as advertised

  13. Statewide Medicaid Managed Care • Builds directly on the foundation of Medicaid Reform • All 67 counties • Almost all patient groups • Full capitation – all plans paid like HMOs (fixed amount per patient) • New risky elements not in Reform Many conflict with federal law, Reform waiver extension

  14. Built on Foundation of Reform Experiment

  15. Medicaid Managed Care Timeline

  16. Medicaid Managed Care Timeline

  17. Medicaid Expansion ACA expands Medicaid coverage to most people with incomes less than 133% of the poverty level (about $22,000/yr for a family of 3). • Starting in 2014 • Florida must expand Medicaid eligibility • More low-income working parents & people with disabilities eligible • Childless low-income adults eligible for first time • Florida must maintain existing Medicaid & CHIP eligibility criteria • Unfair “asset test” is eliminated

  18. Medicaid expansion under the Affordable Care Act

  19. Medicaid expansion and other coverage under ACA (2014) FPL 400% 300% 200% 100% Unsubsidized Exchange Subsidized 200% 185% 133% Medicaid Expansion 133% 2014 74% 22% 0% 0% Children Pregnant Women Parents Seniors & People with Disabilities Adults w/o Children Undocumented Immigrants ■Medicaid and CHIP (Florida 2011 eligibility levels) ■Uninsured or insured via other coverage source

  20. What is a Health Insurance Exchange? 2014 Individuals Basic Health IT Systems/database Qualified Health Plans Web/application portal Policy/Regulatory Small Businesses SHOP Exchange IRS SSA SHOP Qualified Health Plans

  21. Florida’s ACA Implementation Status Leads multi-state legal challenge Passed joint resolution to negate minimum essential coverage Halted all implementation activities Declined to enforce protections or monitor compliance Requested MLR waiver ACA

  22. Florida’s ACA Implementation Status • $100 million turned down • Cancer prevention • Community health clinics • Consumer assistance • Exchange planning • Rate review

  23. HealthCare.gov CuidadoDeSalud.gov

  24. Questions? Laura GoodhueExecutive DirectorFlorida CHAIN laurag@floridachain.orgwww.floridachain.org

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