AHCA eyes changes in disenrollment rules

MEDICAID - Glowing Neon Sign on stonework wall
The agency will hold a public meeting Dec. 17 on the proposed changes.

The state released a proposal this week to change rules about when Medicaid beneficiaries can disenroll from managed care plans.

The Agency for Health Care Administration will hold a public meeting Dec. 17 on the proposed changes.

AHCA is proposing to change a rule to delete language that currently allows certain Medicaid beneficiaries to disenroll from managed care plans if they are receiving a ”medically necessary, active and continuing course of treatment” from an out-of-network provider who is participating in another managed care plan’s provider network.

Additionally, the proposal would change from “good cause” to “cause” the reasons why Medicaid beneficiaries can disenroll from plans.

AHCA initially announced that it would alter its rules in August but didn’t release a specific plan until Monday. Florida had 3.4 million Medicaid beneficiaries as of Oct. 30. The majority of them are enrolled in the state’s mandatory Medicaid managed care program.

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Republished with permission from the News Service of Florida.

News Service Of Florida

The News Service of Florida provides journalists, lobbyists, government officials and other civic leaders with comprehensive, objective information about the activities of state government year-round.


One comment

  • Sonja Fitch

    November 28, 2020 at 2:54 pm

    Why????? Why not??? Pandemic care may be best handled by a provider out of network in one plan but in another! Wtf is the scam?

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