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Medicaid Reform Progress Report
The glitches in Florida’s Medicaid reform pilot program aren’t likely to derail an expansion across the state.
HOPEFUL SIGNS AND QUESTION MARKS
One part of the pilot allows participants to opt out of Medicaid and apply their Medicaid premiums toward purchasing a private health plan. The idea is that Medicaid recipients who work for companies that offer health insurance can use their Medicaid allotments to purchase a plan that’s better or includes more family members. As of the end of August, however, only nine people had enrolled in the program. It appears that most who are eligible for Medicaid don’t work for companies that offer healthcare, says Paul Duncan, the University of Florida professor who is leading the state-funded evaluation of Medicaid Reform.
Another part of the pilot is an “enhanced benefits” program for Medicaid participants who take steps toward a healthier lifestyle. Getting routine mammograms, stopping smoking or participating in disease management programs for chronic illnesses, for example, earns participants up to $125 per year with which they can purchase things like non-prescription pain medication, bandages, heating pads and other over-the-counter medical products.
Participants have responded, accumulating a total of $4.3 million in their accounts as of June. But they had spent only $131,493. It’s unclear whether people are saving up their credits, don’t understand the plan or are having difficulty using the credits at pharmacies. The state has put together a laminated information sheet to help participants and pharmacies better understand the program.
To help beneficiaries decide on a plan, the state operates a call center with more than 30 “choice counselors” and has stationed 10 counselors in Broward County and six in Duval, Baker, Clay and Nassau counties. Because of the counseling, more than two-thirds of enrollees selected a managed care plan and did not have to be randomly assigned to a plan, says Arnold.
Medicaid Reform Enrollment in the five biggest plans (as of June) |
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Broward County |
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Provider | Plan |
Members |
% of Medicaid Enrollees |
Staywell (WellCare) | HMO |
25.651 |
24.4% |
HealthEast (WellCare) | HMO |
14,087 |
13.4 |
Amerigroup | HMO |
10,189 |
9.7 |
Humana | HMO |
9,928 |
9.4 |
Pediatric Associates | PSN (Provider Service Network) |
9,721 |
9.3 |
Duval County
|
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HealthEast (WellCare) | HMO |
35,995 |
52.1% |
First Coast Advantage (Shands/Jax) | PSN |
14,953 |
21.6 |
United Healthcare | HMO |
7,532 |
10.9 |
Access Health Solutions | PSN |
6,725 |
9.7 |
Staywell (WellCare) | HMO |
2,469 |
3.6 |
Source: Florida Agency for Health Care Administration
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