By Laura Summer, Georgetown University Health Policy Institute

Florida’s new Medicaid Managed Long-Term Care program is in place in six regions of the state and will be fully operational statewide by March 1, 2014.  Planning for this new program has been in the works for several years. In 2011, the Florida legislature established the two-part Medicaid Managed Care program. The Long-Term Care (LTC) program is the first part to be implemented. The Medicaid Managed Medical Assistance (MMA) Program for medical services will be introduced later 2014.

The mandatory transition of large numbers of consumers who use long-term care services from fee-for-service to managed care is unprecedented in Florida. Medicaid long-term care services are available to low-income consumers who meet financial eligibility requirements and need assistance with activities of daily living such as bathing, dressing, or transferring to and from a wheelchair. A significant portion of beneficiaries have cognitive impairments.

Florida is conducting the LTC program transition in phases, an important feature, which provides the opportunity to make adjustments as needed. This phased approach also provided an opportunity to conduct early research to understand which aspects of the program were working well or were in need of adjustment and to study how consumers were affected. Lessons from early phases of the can guide subsequent activity in both the LTC and MMA programs.

Two Florida funders – the Jessie Ball duPont Fund and the Winter Park Health Foundation – sponsored research conducted at Georgetown’s Health Policy Institute in 2011 to take a look at the proposed program changes. At the start of the new program, they were joined by four other organizations – AARP Florida, Alleghany Franciscan Ministries, the Health Foundation of South Florida, and the Quantum Foundation – to sponsor new research that describes early LTC program activities. The research draws on interviews with stakeholders across the state and features data supplied by Florida’s Agency for Health Care Administration, which administers the programs. Among our chief findings:

• Despite considerable planning and a phased program launch, many details were unclear as operations began. A number of good program policies to help ensure smooth transitions were in place, but respondents reported that complete information about plan networks was not always available early on. Although payment for current providers was assured during the transition period, questions about billing and payment procedures persisted. Respondents consistently suggested that transitions would be smoother if implementation timeframes were extended. 

• State data show that more than one-third of enrollees failed to choose managed care organizations initially. This suggests that more aggressive outreach and counseling efforts are needed. Florida relied heavily on mailed notices to get the word out about the program, but experience from other states shows that consumers do not always receive, open, read, or understand their mail and therefore pro-active follow-up with non-respondents on the part of program staff can be very helpful. 

• The recruitment of case managers and other staff from community-based organizations to managed care plans posed challenges for local organizations and consumers who rely on them.  Among all of the long-term care consumers, those who receive community-based services are most likely to face disruptive situations and to need advice from organizations and individuals who they know and trust. 

• Medicaid long-term care consumers will face another hurdle when the MMA program is introduced, adding complexity to coverage decisions. Most consumers will have to navigate separate long-term and medical care systems and could be enrolled in multiple plans. This development will make the program goal of delivering coordinated, person-centered services very difficult to achieve. The need for education and counseling activities will continue well into 2015 as will the need for more attention to service coordination. 

• Observers were uncertain about whether key program goals would be achieved. The cap on community-based slots in the new program will make a meaningful shift from institutional to community-based services difficult to achieve. Many respondents also wondered whether service quality improvements and program savings could both be achieved initially. 

Outstanding questions about the impact that Medicaid managed care will have on the long-term care population underscore the need for ongoing monitoring on the part of all stakeholders. Therefore, we also developed a tool kit to help stakeholders work collaboratively to monitor program activity and outcomes.