Medicaid Archives - Florida Politics

Economists find good news for schools, bad news for Medicaid

State economists on Monday found millions of extra dollars for the state’s public schools, but also a $29 million shortfall in takings from tobacco taxes and a landmark legal settlement with the tobacco companies.

The Revenue Estimating Conference projected that $128.4 million would remain unspent at the end of this fiscal year within the Educational Enhancement Trust Fund and the State School Trust Fund, financed primarily through Florida Lottery proceeds, slot machine taxes in South Florida, and proceeds from the sale of unclaimed property.

That means the Legislature will start out in the black when setting school spending priorities for the 2019-2020 fiscal year, said Amy Baker, coordinator for the Florida Office of Economic and Demographic Research.

“It’s nonrecurring, but it’s a boost for schools,” Baker said. “It’s more than they expected, right from the get-go.”

On the other hand, the outlook for Medicaid — the primary recipient of the tobacco money — “is not good news,” she added. “It’s showing that they actually have a projected hard deficit.”

Medicaid is the joint state-federal health care program for the poor. “So, good news for education, not good news for Medicaid,” Baker said.

The economists warned of the problem last week, blaming it on a decline in tobacco use and a shift to vaping products that remain untaxed in Florida.

Moreover, R.J. Reynolds is in court contesting its obligation to continue payments under a 1998 legal settlement in light of its sale of cigarette brands to Imperial Tobacco Group.

The group has spent most of August reviewing its revenue forecasts, and planned to huddle again on Thursday to sign off on a projection for the General Revenue Fund, the main source of money to build a state budget besides trust funds.

AIDS foundation files records case against Rick Scott

The AIDS Healthcare Foundation filed a public-records lawsuit Thursday in Leon County circuit court alleging that Gov. Rick Scott’s staff refused to provide copies of his public calendar and travel schedule.

The lawsuit came after the group said it tried to contact the governor about concerns with the state Agency for Health Care Administration’s recent decision to not renew Medicaid contracts in Broward, Miami-Dade and Monroe counties for an AIDS Healthcare Foundation managed-care plan known as Positive Healthcare.

The foundation also has filed a legal challenge about the contracts in administrative court. If it loses in administrative court, more than 2,000 patients with HIV and AIDS will have to enroll in a different Medicaid managed-care plan.

The new lawsuit alleges that the AIDS Healthcare Foundation asked Scott’s office for copies of the governor’s electronic calendar and hard-copy calendars showing all meetings, events and appearances for Scott from July 20 through Oct. 31. It also requested all documents and records that indicate where Scott will travel — and reside — for those months. Also, the organization wants a list of all campaign and fundraising events Scott will attend as part of his race for the U.S. Senate.

Imara Canady, regional communication and community engagement director for the Southern bureau of the AIDS Healthcare Foundation, said Scott has made increasing transparency a campaign promise in his bid for the U.S. Senate but has failed to deliver on that as governor.

“What exactly is he doing? Where is he now? No one seems to know what he’s doing as governor,” Canady said.

The governor’s office did not immediately comment on the lawsuit.

Medicaid enrollment expected to keep dropping

The number of Medicaid patients in Florida could be decreasing like never before.

Members of the state’s Social Services Estimating Conference on Wednesday agreed to revise downward overall Medicaid enrollment estimates for fiscal year 2018-2019 from 4.02 million people to 3.86 million people.

Moreover, economists on the panel said there were about 500,000 fewer people served by the Medicaid program in fiscal 2017-2018, which ended June 30, than previously projected.

“Medicaid caseload has been dropping month over month and overall,” said Tom Wallace, assistant deputy secretary for Medicaid finance and analytics at the Agency for Health Care Administration. “It’s really something that we haven’t really seen, or at least I haven’t seen, in the program ever here … that we’ve seen consistently a drop in caseloads month after month.”

Wallace attributed the lower-than-expected enrollment to, among other things, the state’s decision to have the firm Equifax begin confirming salary information for people who apply for the Medicaid program.

Medicaid pays health care costs of poor, elderly and disabled people, so when the economy is strong there are fewer beneficiaries in the program.

While Medicaid enrollment is dropping, economists agreed that enrollment in the Florida KidCare program is on the rise. Florida KidCare is a subsidized insurance program that provides coverage to children whose families make too much money to qualify for Medicaid.

Unlike Medicaid, Florida KidCare requires families to pay a portion of premiums. For the current fiscal 2018-2019 budget, lawmakers assumed a 6 percent increase in enrollment in the program, but economists now say they expect the growth to be closer to 6.5 percent.

While the difference between the projections isn’t great for fiscal 2018-2019, the gap between projections and actual KidCare enrollment was larger for the fiscal year that ended June 30. Lawmakers estimated that enrollment in KidCare for fiscal 2017-2018 was going to be 5.23 percent higher than the previous year’s enrollment, but it grew by more than 10 percent.

The increase was attributable to an increase in referrals from the Medicaid program and targeted advertising efforts.

The Social Services Estimating Conference, which is made up of representatives from the governor’s office, legislative staff and the Office of Economic and Demographic Research, will meet Aug. 6 to discuss projected expenditures in Medicaid and KidCare.

Republished with permission of the News Service of Florida.

Andrew Gillum challenges ‘What’s impossible?’ in first TV ad

Democratic gubernatorial candidate Andrew Gillum is challenging thinking about what’s impossible in his first television commercial, being launched today with a modest buy that will ramp up next week.

Gillum’s 30-second spot, “What’s impossible?”, seeks to define him as someone who already has a record of succeeding against long odds, as the son of the bus driver who grew up to become Tallahassee’s mayor and win a lawsuit against the National Rifle Association. The ad also offers Gillum’s promises to increase public education spending by $1 billion, and to accept the federal Medicaid expansion.

Running the lowest-budget campaign among the five Democrats and two Republicans seeking the governor’s office this year, Gillum’s commercial touts that underdog status and explicitly asks those viewing it to contribute to his campaign to keep the commercial on the air.

“Is it impossible to come from nothing, to be outspent ten to one, and win?” he asks. “Share this, buy a TV ad and prove the impossible.”

His campaign is spending $60,000 now to put it on statewide cable, including on CNN and MSNBC, starting Wednesday, and said it would make a six-figure purchase to put it on broadcast TV in Tampa, Orlando and West Palm Beach starting next week.

Gillum faces Jeff Greene, Philip Levine, Chris King, and Gwen Graham in the Aug. 28 Democratic primary. The first three have poured millions of dollars of their own money into their campaigns and all four have campaign funds far in excess of Gillum’s, though Gillum also has a political committee that has raised a couple million dollars, mainly through out-of-state donors.

Judges set to hear Medicaid challenges

Twenty-seven legal challenges filed by managed-care plans protesting state decisions to award $90 billion in Medicaid contracts have been grouped into five cases that will be heard in administrative court next month.

A review of state Division of Administrative Hearings records shows that, for the most part, judges have agreed to consolidate challenges by the types of patients that managed-care plans would serve.

For instance, Administrative Law Judge Robert Kilbride consolidated three challenges that were filed by two companies about the provision of specialty care for people with HIV — the virus that causes AIDS — and AIDS. He is scheduled to hear the challenges Aug. 7.

The state Agency for Health Care Administration announced in April that it would sign a statewide specialty contract with Clear Health Alliance to provide services to people with HIV and AIDS. The AIDS Healthcare Foundation, which operates the managed-care plan known as Positive Healthcare, filed challenges in Medicaid regions 10 and 11, which encompass Broward and Miami-Dade and Monroe counties, respectively. The South Florida Community Care Partnership, a managed-care plan run by the North and South Broward hospital districts, filed a challenge in Region 10.

Managed-care plans filed the 27 challenges after the Agency for Health Care Administration awarded contracts in 11 different regions of the state to provide various types of care. The contracts range from caring for Medicaid beneficiaries with conditions such as HIV and AIDS to “comprehensive” contracts that include providing care to broad swathes of beneficiaries, including people who need long-term care.

Similar to the handling of the HIV and AIDS contract challenges, Administrative Law Judge R. Bruce McKibben, agreed to consolidate 14 challenges filed by three companies over the provision of specialty care for people with serious mental illness. He is scheduled to hear the cases Aug. 8.

McKibben consolidated challenges that were filed by Coral Care, which wanted to provide services to people with serious mental illness in Medicaid regions 8 and 11; one challenge filed by the South Florida Community Care Network, which wanted to provide specialty services to Broward County residents; and 11 challenges filed by Magellan Health Care, which wanted to provide care to people with serious mental illness statewide. Medicaid Region 8, sought by Coral Care, includes seven counties in southwest and south-central Florida.

Administrative Judge Lawrence Johnston, meanwhile, has agreed to consolidate nine challenges filed by two companies regarding the provision of specialty care to children with complex medical needs. Those challenges — eight filed by Our Children’s Provider Sponsored Network and one filed by the South Florida Community Care Network — are scheduled to be heard Aug. 6 and Aug. 7.

The only challenge that stands alone is a case filed by Best Care Assurance. The provider-sponsored network, a type of managed-care plan, filed a challenge after the state Agency for Health Care Administration agreed to award Molina Healthcare a “comprehensive” contract for Medicaid Region 8. Molina was awarded the contract as part of a settlement agreement reached with the state.

But Best Care Assurance said state Medicaid law limits to four the number of managed-care plans the state can contract with for Region 8, made up of Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. In its challenge, the health plan argues the state has contracted with five plans in the region. Administrative Law Judge Linzie F. Bogan will hear the challenge Aug. 15.

After approval from lawmakers in 2011, the Agency for Health Care Administration in 2013 launched a program that requires most Medicaid beneficiaries to enroll in managed-care plans. The agency initially signed five-year contracts with health plans across the 11 regions. It began reprocurement efforts in 2017, issuing an invitation to negotiate with managed-care plans that want new five-year contracts.

After months of reviews and negotiations, AHCA has announced the 13 managed care plans it intends to contract with. In aggregate, the five-year contracts are expected to be worth about $90 billion, one top-ranking Medicaid official has said.

Some health plans with existing contracts, such as Positive Healthcare and Magellan Health Care, were not chosen for the new round of contracts, prompting them to file legal challenges. Other health plans that were new to the market also challenged the state’s decisions.

Meanwhile, with existing Medicaid managed-care contracts set to expire at the end of the year, AHCA announced last month a timeline for transitioning to the new plans.

Southeast Florida, from St. Lucie County south to Monroe County, will be the first area of the state that transitions from the old to the new contracts, with Dec. 1 as the target date.

The target date for the state to transition from the old to new contracts for Medicaid regions 5,6, 7 and 8 is Jan. 1. Those regions include 18 counties, stretching across Central Florida from Pinellas County to Brevard County and in Southwest Florida.

Most of the northern half of the state — stretching from Escambia to Volusia and Lake counties — will be the last area for the change in health care plans, with a Feb. 1 target date to transition to the new contracts.

To see AHCA’s proposed rollout click here.

Republished with permission of the News Service of Florida.

Gwen Graham buys TV time in Jacksonville, West Palm Beach

Democratic gubernatorial candidate Gwen Graham is finally going up on television in Jacksonville and West Palm Beach.

Per a media release from her campaign: “The new ad, ‘Lessons,’ introduces Graham as a mother, former PTA president, congresswoman, and daughter of popular former Governor and Senator Bob Graham. Like her previous ads, the new spot contrasts 20 years of Republican rule with Graham’s progressive priorities of restoring public schools and expanding health care.”

“Everything I do is through the prism of being a mom,” Graham says in the ad. “The Florida Legislature have not taken Medicaid expansion. They have hurt education. They have used the lottery to reduce funding — but we’re gonna take it back.”

The media release notes that despite having spent just $3.8 million this campaign, “far less than her self-funding opponents” Jeff Greene and Philip Levine, Graham is still in the mix in polls. The results of a recent survey conducted by St. Pete Polls and commissioned by Florida Politics shows Graham ahead of Levine and trailing Greene by just a tenth of a percentage point.

The ad’s message will be familiar to those paying attention to this campaign.

“Twenty years with one party running everything…with all the wrong priorities. The Florida Legislature have not taken Medicaid expansion they have hurt education. They have used the lottery to reduce funding — but we’re gonna take it back,” Graham says in the spot.

Medicaid contracts challenged in Southwest Florida

A move by state health-care regulators to avoid litigation has, instead, created more.

Attorneys for Best Care Assurance, a managed care plan affiliated with Lee Memorial Health System, notified the state that they plan to challenge a decision last week to award a Medicaid contract to Molina Healthcare of Florida in a seven-county region of Southwest Florida.

The state decision would bring to nine the number of managed care plans for Medicaid patients over the next five years in what is known as Medicaid Region 8. The region includes Sarasota, DeSoto, Charlotte, Glades, Lee, Hendry and Collier counties.

The state Agency for Health Care Administration last week decided to award Molina Healthcare a contract to provide “comprehensive” care in the region, meaning it would provide acute-care services and long-term care.

Best Care Assurance, which will operate under the name Horizon Health Plan, was awarded a contract in April in Medicaid Region 8. Immediate attempts to contact attorneys or officials from Best Care Assurance about the legal challenge were unsuccessful.

Florida lawmakers in 2011 approved a plan to revamp the Medicaid system and require most beneficiaries to enroll in HMOs or other types of managed-care plans. The state awarded contracts to health plans in 11 different regions of the state, and AHCA is now finishing a second round of contracting.

AHCA announced in April its selection of health plans for five-year contracts, estimated to be worth about $90 billion overall. Molina Healthcare, which has been under contract with the state to provide care to Medicaid patients in eight regions, would have been shut out of Florida’s $29 billion Medicaid program if the agency’s initial April 24 decision stood.

But the contract decisions were challenged by a dozen managed care plans, including Molina Healthcare. Since then, AHCA has awarded contracts to four more health plans bringing to 13 the number of companies that will share the business.

To settle Molina’s challenges, AHCA agreed to award the plan contracts in Medicaid Region 8 and Medicaid Region 11, which covers Miami Dade and Monroe counties. About 200,000 patients are enrolled in Medicaid managed-care plans in the seven Southwest Florida counties.

Though the settlement agreement meant that Molina Healthcare would have a drastically reduced footprint in the Medicaid program, it kept the plan in Region 8. Company Vice President of Operations Pamela Sedmak said last week the company was “thrilled” because the settlement allowed it to “recover over one-third of the revenue we did have in the state.”

Laura Murray, a spokeswoman for Molina Healthcare, had no comment on the Best Care Assurance challenge.

Meanwhile, legal challenges remain from companies that want to provide “specialty” services, including providing care to people with HIV and AIDS or serious mental illnesses.

One of those challenges that’s still outstanding was filed by Coral Care, which is challenging the state’s decision to award a mental-health specialty contract to WellCare of Florida in Medicaid Region 8.

Republished with permission of the News Service of Florida.

Philip Levine talks Medicaid expansion, pre-existing conditions in new ad

Former Miami Beach Mayor Philip Levine is out with a new ad for his gubernatorial campaign detailing his plan to fix Florida’s health care system.

The 30-second spot, “Remedy,” is Levine’s first ad covering health care since he hit radio in the early phase of his campaign with English- and Spanish-language ads encouraging listeners to sign up for health care plans through the Affordable Care Act marketplace. It’s backed up by a $1 million ad buy.

The new ad features Levine speaking with patients in a clinic waiting room as he talks about health care in Florida and his plans to fix the problems with it.

“This is where families come for help, but we’re now ranked almost dead last for health funding, leaving thousands of Floridians on waiting lists fighting for their lives,” Levine says in the ad. “I’m Philip Levine and I’m running for Governor to give everyone the health care they need.”

Levine then details his health care plan: “We will expand Medicaid, end the waiting lists, and unlike the president we will cover pre-existing conditions, because no one should go to bed at night fearing they can’t afford to wake up.”

Though health care has been a staple of Democratic campaigns for a decade, the issue has been forced to take a back seat for the past several months of the 2018 election cycle as Puerto Rican migration, gun control, and most recently immigration issues have dominated much of the dialogue in the race to replace term-limited Republican Gov. Rick Scott.

Levine is running against Tallahassee Mayor Andrew Gillum, former Congresswoman Gwen Graham and Orlando-area businessman Chris King in the Democratic primary. Palm Beach billionaire Jeff Greene joined the field at the beginning of June.

Graham also recently released an ad saying she would expand Medicaid if elected governor and the other candidates have stated they would do the same, often using the topic to ding Scott for his flip-flop on expanding the federal and state health insurance program for the very poor.

To date, Levine leads the pack in fundraising with more than $15 million raised and more than $10 million spent so far, including a substantial amount of self-funding. That could change in the coming weeks depending on how deep Greene is willing to dig into his own pockets — he has told multiple media outlets that he is willing to spend “whatever it takes” on his campaign.

The ad is below.

Critics take aim at Medicaid change

A move by Gov. Rick Scott’s administration to eliminate a long-standing policy that gives poor, disabled and elderly Floridians 90 days to qualify for the Medicaid program isn’t getting support from people who care for patients or from patients’ family members.

More than 100 comments from people such as physicians, nursing-home and hospital executives and family members were sent to the federal government opposing the proposed change, which the Scott administration submitted for approval in April.

If the change is approved by President Donald Trump’s administration, the state would save an estimated $98 million in Medicaid spending this year. The change would eliminate a three-month window where Medicaid pays health care bills while people apply for the program.

Florida isn’t alone in moving ahead with eliminating the policy, but unlike other states that have made similar decisions, Florida has not expanded Medicaid eligibility to include able-bodied working adults.

American Academy of Family Physicians board Chairman John Megis said in his written comments on the proposal that Medicaid reimburses physicians less than Medicare or commercial health insurance plans and that eliminating the 90-day window could be a step too far.

“Should it be eliminated, it would pose more uncertainty to our members, especially those in rural or underserved areas, who are already operating on thin margins,” Megis wrote. “We fear the elimination of retroactive coverage would further dissuade physicians from treating Medicaid populations, further entrenching the health disparities facing the state, and leave others unable to offer services to vulnerable Medicaid populations altogether.”

One caregiver, whose name wasn’t published on the federal Centers for Medicare & Medicaid Services website, shared a story about the caregiver’s mother, who has Alzheimer’s disease and lives in an assisted living facility.

While the family is tapping into savings to pay for the facility, the caregiver worries that the mother may require nursing home care and would then need to enroll in Medicaid. The caregiver said the current policy allows families to focus on choosing the right nursing home instead of worrying about filling out applications.

“I know the state claims their costs will be ‘more predictable’ if this amendment is approved, but medical emergencies are NOT PREDICTABLE. Many ordinary people like myself and my family are dealing with serious illnesses and trying to do the best we can,” the caregiver’s comment said. “If the leaders of our state think saving money is more important than HUMAN LIVES I pray to God for the future of our country.”

If the change is approved by Centers for Medicare & Medicaid Services, Florida residents would have to apply for the Medicaid program the same month they get sick. That means, for example, if a patient was admitted to a hospital on April 10, the hospital — working with the patient — would have 20 days to gather information needed to properly fill out the Medicaid application.

However, a patient admitted to the hospital on April 29 would have just one day to gather what is needed to submit the application.

The Centers for Medicare & Medicaid Services, commonly known as CMS, has given Iowa and Kentucky the go-ahead to eliminate retroactive eligibility, but those states expanded Medicaid under the Affordable Care Act to able-bodied adults.

Florida has not. As a result, Medicaid is limited to people such as pregnant women, children, seniors and people with disabilities. Exempting pregnant women and children from the proposal means that the majority of the 39,000 people impacted by the change would be seniors and people with disabilities.

In his comments, Florida Health Care Association Executive Director Emmett Reed said the state should maintain the 90-day window. If the change is approved, though, people should be given 30 days after first being admitted to nursing homes to apply for the program, Reed said. He also predicted in his comments that if the change is approved, there “will be an increase in incomplete Medicaid applications submitted to (the state) and a decrease in the timely processing of Medicaid applications.”

Agency for Health Care Administration spokeswoman Mallory McManus dismissed the criticisms and said the policy change was “about paperwork, not patient care.” She said the proposal focused on quick enrollment into the Medicaid program.

“By enrolling individuals quickly, you ensure better-coordinated fully integrated care, as well as access to preventative services,” McManus said.

But Anne Swerlick, a health care attorney with the Florida Policy Institute, noted that most low-income adults in Florida are prevented from accessing coverage when they are healthy, or even when they suffer from serious chronic conditions, so there isn’t an opportunity to coordinate care and provide preventive services.

“It’s a cruel irony that Florida’s justifications for cutting (retroactive Medicaid eligibility) are the best arguments for why Florida needs to expand its Medicaid program,” Swerlick said.

Republished with permission of the News Service of Florida.

Two more health plans get Medicaid contracts

Two health plans that would have been locked out of Florida’s Medicaid market for the next five years were awarded state contracts after they threatened legal action.

Prestige Health Choice and Molina Healthcare will each be awarded contracts in two of Florida’s 11 Medicaid regions, the state announced late Monday. Moreover, the state announced it will award additional Medicaid managed-care contracts to Aetna Better Health of Florida, UnitedHealthcare of Florida and Simply Healthcare.

As a result of the decisions, Agency for Health Care Administration spokeswoman Mallory McManus said the state has settled legal challenges involving what are known in the Medicaid program as “managed medical assistance” contracts and “comprehensive” contracts. Plans with managed medical assistance contracts will provide services for general and acute health-care needs, from childhood checkups to surgeries. Comprehensive plans will also offer long-term care such as skilled nursing services.

However, legal challenges remain from companies that want to provide “specialty” services, including providing care to people with HIV and AIDS or serious mental illnesses. The state faces challenges from the AIDS Healthcare Foundation and Magellan Complete Care, among others.

Monday’s announcement brought to 13 the number of managed care plans that will sign contracts with the state for managed medical assistance and comprehensive care. The five-year contracts, in total, are estimated to be worth upwards of $90 billion.

Florida lawmakers in 2011 approved an overhaul of the Medicaid system to require most beneficiaries to enroll in HMOs and other types of managed-care plans. The state awarded an initial round of contracts and now is finishing a second round.

Under the announcement Monday, Molina has been awarded contracts to provide comprehensive services in Medicaid Region 8, which covers Sarasota, DeSoto, Charlotte Glades, Lee, Hendry and Collier counties, and Medicaid Region 11, which is made up of Miami-Dade and Monroe counties.

Currently, the company covers about 105,000 people in the two regions and is paid about $550 million annually for providing the care in those regions.

The California-based health plan has the third-largest market share in the Medicaid managed care program with contracts in eight Medicaid regions that are set to expire at the end of the year.

Before reaching the settlement with the state announced Monday, the plan would have been shut out of the Medicaid program going forward.

Pamela Sedmak, Molina Healthcare vice president of health plan operations, said the company was pleased it was able to persuade the state to alter its initial decisions.

“We weren’t awarded anything at all from the state (initially),’’ Sedmak said. “When you are starting from that position as you enter into settlement negotiations, we were thrilled to be able to recover over one-third of the revenue we did have in the state, and to continue our relationship with the state and providers there because this is a strategically important state.”

Meanwhile, Prestige Health Choice has been awarded managed medical assistance contracts in Medicaid Region 9, which includes Indian River, Okeechobee, St Lucie, Martin and Palm Beach counties, and Medicaid Region 11, which covers Miami Dade and Monroe.

Prestige Health Choice currently operates in eight Medicaid regions but, similar to Molina, would have been locked out of the program for the next five years had the state not modified its decisions.

AHCA officials went through a lengthy contracting process for the managed-care program. Florida law mandates that contracts be put back out to bid every five years.

While AHCA’s decisions keep Molina and Prestige in the Medicaid market, it also agreed to award additional Medicaid contracts to three other health plans.

Aetna Better Health of Florida will be awarded contracts in Medicaid regions 6 and 7, which are made up of nine Central Florida counties and include Tampa and Orlando.

UnitedHealthcare of Florida was awarded managed medical assistance contracts for Medicaid regions 3 and 4, which include areas in North Central Florida and the East Coast from Daytona Beach to Jacksonville.

Simply Healthcare was awarded an additional managed medical assistance contract in Medicaid Region 5, which is made up of Pinellas and Pasco counties, and a comprehensive contract in Medicaid Region 10, which is Broward County.

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