Health care agency reaches out to HMOs and nursing homes about fate of Medicaid reform

The following article was published in The Florida Current on August 25, 2011:

Health care agency chief speaks to HMOs and nursing homes about the fate of Medicaid reform

By Christine Jordan Sexton

Agency for Heath Care Administration Secretary Liz Dudek has been making the rounds to special interests groups discussing Florida’s new Medicaid managed care program and the waivers required to make it all work.

The move comes at a critical time when Florida remains mired in negotiations with federal officials over the fate of the $22 billion Medicaid program and whether the state can win approval of changes it is seeking. State lawmakers earlier this year approved a sweeping overhaul.

At the behest of the Florida Association of Health Plans Dudek, and her top lieutenants,  including outgoing Deputy Medicaid Director Roberta Bradford and interim Medicaid director Justin Senior, on Tuesday attended a teleconference staged by the association for its Medicaid HMO members.

FAHP President Michael Garner said he asked Dudek whether she’d be willing to discuss Medicaid 1115 negotiations with his members and the secretary accepted. According to Garner, Dudek asked whether the meeting could be opened up to non-FAHP members, which it was.

“When the agency asked if we could include other people, we said absolutely,” said Garner.

According to the AHCA spokeswoman Shelisha Coleman, the agency invited seven provider service networks to the teleconference, including First Coast Advantage, South Florida Community Care Network, Integral, Prestige, Children’s Medical Services Specialty PSN, Better Health, and a new PSN called We Care.

In all, 39 people–mostly representatives of HMOs– listened to Dudek discuss the waiver negotiations, according to a list of attendees provided by the health plan association.

Garner said the group’s “sole interest”  was to have Dudek “share with us the negotiation issues.”

Garner said Dudek told the group negotiations were going well and that they were partly educational. She told the HMOs that there were “a lot of questions” regarding the Low Income Pool, or the $1 billion allotment from the federal government to help pay the costs for the underinsured and uninsured.

Garner said Dudek said she has tried to explain the achieved savings rebate–which the Legislature required in lieu of medical loss ratios–which is part of the Medicaid overhaul. Garner said Dudek told federal officials that there is an MLR component built into a shared savings model. Medical loss ratios require that a certain amount of care be spent on direct care to patients.

Florida secured a sweeping Medicaid 1115 waiver under former Gov. Jeb Bush who successfully negotiated with the Centers for Medicare and Medicaid Services, when his brother, George W. Bush was president. The waiver expired June 30 and the state, unable to get the current administration to extend the waiver for another three years, has had to rely on temporary extensions.

The Medicaid 1115 waiver is important on two fronts. It allows a near-mandatory managed care program to operate in five counties and establishes the Low Income Pool. It also is the linchpin for Florida’s new mandatory Medicaid managed care program that will be expanded statewide. The new program will require most Medicaid patients, old and young, to enroll in managed care plans. That program was passed by the Legislature in 2011.

In addition to addressing the managed care industry Dudek on Tuesday also participated in a teleconference call that was organized by Rep. Ray Pilon, R-Sarasota. According to Pilon’s office, the discussions with Dudek focused on long term care and nursing homes and the local media was invited to attend.

Dudek on Thursday also traveled to Orlando at the request of Rep. Darren Soto, D-Orlando, to meet with doctors to discuss the changes to the changes to the Medicaid program.

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