Statewide Medicaid Managed Care Update Beth Kidder Assistant Deputy Secretary for Medicaid Operations Presented to the Florida Commission for the Transportation Disadvantaged February 3, 2012

Overview of 2011 Legislation In 2011, the Florida Legislature created Part IV of Chapter 409, Florida Statutes, which directed the Agency to implement the Statewide Medicaid Managed Care program. The Statewide Medicaid Managed Care program has two key program components: –the Long-term Care Managed Care program –the Managed Medical Assistance program All Medicaid recipients are required to enroll in a managed care plan unless specifically exempted in the legislation. Certain recipients are required to enroll in the Long-term Care Managed Care Managed Care program. 2

Why Change the Program? The goals of Statewide Medicaid Managed Care program are: –patient centered care, personal responsibility and active patient participation –provide for fully integrated care through alternative delivery models with access to providers and services through a uniform statewide program –implement innovations in reimbursement, quality and increased plan accountability. 3

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Status of SMMC Implementation Federal authority has been requested to implement key provisions Communication with federal CMS has begun to negotiate program approval Project management and team structure implemented 5

Federal Authority Requested Seeking amendment of the 1115 Medicaid Reform Demonstration Waiver: –To mandatorily enroll most Medicaid recipients in Statewide Medicaid Managed Care plans –To allow health plans to develop customized benefits packages –To implement the SMMC on a statewide basis –To impose additional premiums and co-payments as required under the SMMC program Agency has received informal questions from CMS regarding Amendment #1 (statewide expansion) and is in the process of preparing a response. 6

Federal Authority Requested Seeking a new 1915 (b)(c) waiver to implement the Long- Term Care component of the SMMC program –To identify and allow qualified individuals to receive home and community based care services in lieu of nursing home care services. –To enroll individuals in managed care plans statewide, and to allow for selective contracting of those plans. The Agency has responded to formal requests for additional information on both the 1915(b) and (c) portions of the waiver. 7

Project Phases Design –Setting foundations –Submitting applications (waivers, concepts, state plan amendments) Pre-Implementation –MCO Solicitation –Contract Execution Implementation –Outreach and Enrollment Post Implementation 8

Next Steps Continue negotiation with Federal CMS for program approval Finalize program development, drafting of procurement and contract documents Continue assessment of Agency organization and potential re-alignment for management of the SMMC program 9

How to find information about program changes Please visit the Agency’s website for: –the status of the waiver to federal CMS –the implementation timeline –the progress of the negotiation and contracting with plans –information for providers and recipients about implementation and plan enrollment as it becomes available. Go to and click on the left, below the picture of the Secretary. –Sign up to receive updates via the website. 10

Questions?