Mary Mayhew seeks managed care extension but eyes future changes

Florida health care officials on Monday formally asked the federal government to extend for two more years a “waiver” to allow the state to keep intact its Medicaid program that relies on steering patients into privately run managed-care plans.

The request, published Monday, doesn’t contemplate making any major immediate revisions to Medicaid, the safety-net health care program for poor people that relies on a mix of state and federal dollars.

But Agency for Health Care Administration Secretary Mary Mayhew told The News Service of Florida that she is going to propose changes to the program in the coming years.

Mayhew said that while there has been an “evolution” in the Medicaid program, “there is so much work that needs to be done” to reward quality and ensure timely access to services. She said that “what we know is Medicaid is still antiquated” and that it “hasn’t really invested in the prevention and early intervention services that can produce far better outcomes.”

Florida, under then-Gov. Rick Scott, decided to overhaul Medicaid and put most patients in managed care as part of an effort to control costs. For purposes of contracting, AHCA divided the state into 11 different regions and negotiated with health plans by region.

It was a major undertaking. But while it has shifted the way the program has operated, it has not resulted in the huge savings that Republicans initially had sought.

Mayhew said her agency has been working for the past year with managed-care plans and other parties on how to make improvements in the system and that her agency is in the “infancy” of getting the right metrics to measure the success of the program.

To operate the statewide managed-care system, Florida needed to obtain what is known as a waiver from the federal government. The waiver is currently set to expire June 30, 2022, but the request published Monday would extend it for two years.

The extension, Mayhew said, would give her agency “more time to evaluate the strategies that can make the biggest difference in improving health-care outcomes.”

Mayhew’s goal is to propose a package of legislative changes to the program for Gov. Ron DeSantis to consider in the fall of 2022, which would be DeSantis’s last year in office unless he is re-elected.

If DeSantis agrees with the proposals, Mayhew said they would be submitted for legislative consideration in 2023. If approved by the Legislature, she said, the state would submit proposed amendments to the federal waiver for consideration in the fall of 2023.

Mayhew said she still anticipates Medicaid would contract with managed-care plans even after her proposed reforms.

Florida’s Medicaid program serves more than 3.8 million recipients with an annual budget of more than $29 billion. Most of those Medicaid members are enrolled in managed-care plans, though some remain in what is known as a “fee for service” system.

The federal Centers for Medicare and Medicaid Services first approved the statewide Medicaid managed-care program in 2014. In addition to authorizing statewide managed care, the waiver allows Florida to operate a supplemental Medicaid financing program known as the Low Income Pool. Though authorized to draw down $1.5 billion in so-called LIP payments, Florida has not been able to take advantage of the full $1.5 billion for the past several years.

Medicaid managed-care contracts are lucrative. According to Medicaid reports, managed-care plans with Medicaid contracts were paid $11.5 billion in 2018.

The state has twice entered into contracts with managed-care plans. The latest round of contracts — said to worth more than $90 billion over a five-year period — went into effect in December 2018 and are set to expire on Dec. 31, 2023.

The Legislature this year approved a measure to allow the contracts to remain in effect until Dec. 31, 2024. That bill (HB 713) has not gone to DeSantis for consideration.

Federal law requires AHCA to hold public meetings and to take public input on the request for the extension. The agency will host webinars June 8 and June 17.

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Republished with permission of the News Service of Florida.