Dental care, workforce shortage and market monopolies targeted in House Medicaid proposal

TALLAHASSEE, FLA. 11/30/21-Tom Wallace, Medicaid director for the Florida Agency for Health Care Administration, speaks during the House Health Care Appropriations Subcommittee, Tuesday at the Capitol in Tallahassee. COLIN HACKLEY PHOTO

Dental care, health care workforce shortages and managed care monopolies are targeted in a proposed rewrite of the state’s mandatory Medicaid managed care program the House released late Tuesday.

The proposed 40-page bill that will be considered by the House Thursday puts dental care back on the list of covered services that contracted Medicaid managed care plans would be required to provide, along with traditional health care services.

The dental provision isn’t the only controversial provision in the proposed bill, though.

In a move that is sure to draw opposition from safety net hospital systems, the House bill would require faculty plans at Florida medical schools and 11 regional perinatal intensive care centers to participate in each Medicaid managed care plan’s network. The providers are mandated to enter the contracts because they have been deemed as “essential” in statute by the state

Essential providers that don’t abide by the contracting mandates won’t be able to receive any form of supplemental Medicaid payments form the state. That could lead to the loss of hundreds of millions in funding for hospitals across the state.

Reports show Florida is facing a looming nursing shortage and nursing homes complaining about a certified nursing assistant shortage. The bill allows contracted health plans to include in their medical expenses money they spend on training nurses or students enrolled in other health care workforce training programs.

The House’s proposal would also prevent Medicaid officials from automatically enrolling Medicaid beneficiaries into any health plans that have more than 45% of the enrollees in the region. The move is aimed at Sunshine State Health Plan, which has more than 38% of the Medicaid managed care marketplace today.

The Legislature in 2011 passed a rewrite of the state’s Medicaid statutes, requiring most beneficiaries to enroll in a managed care plan. In 2013, the Medicaid managed long-term care program was launched. The Medicaid managed medical assistance program, which provides services to women and children, followed in 2014. The law requires the Medicaid contracts to be competitively bid in 11 different regions in the state. Winning health plans are awarded multiyear contracts worth tens of billions of dollars.

Medicaid dental services, and how they are provided, has been one of the more hotly debated issues in the last several years. When the program was launched, oral health and dental care were mandated benefits the plans were required to provide for children.

Former Senate President Joe Negron helped lead the charge to require the state to procure a separate Medicaid dental contract. MCNA Dental hired former Texas Gov. Rick Perry to lobby then Gov. Rick Scott and earn his support for legislation that carved out dental care from the so-called MMA program and led to separate managed dental plans as of March 2019.

Florida Dental Association Chief Legislative Officer Jo Anne Hart said the association supports a separate dental managed care program.

“The FDA supports maintaining the current structure of keeping dental and medical separate under Florida’s Medicaid program to ensure the limited funds available go to direct services. Changing the current program to embed dental with medical services will create administrative barriers, dilute the funds for dental care, and impact the number of dentists willing to participate in the program — leading to decreased access and utilization of care,” she said in a prepared statement to Florida Politics.

The decision by the House to carve dental services back into the Medicaid managed care assistance program is not surprising. A House health care panel heard testimony from Medicaid Director Tom Wallace, who said the agency preferred for dental care to not be bifurcated from traditional health care services.

The House bill would require the Medicaid managed care plans to improve beneficiaries’ dental health as well as increase their utilization of preventive dental services. The bill authorizes the agency to establish performance and outcome measures and to publish relevant data.

The Senate Health Policy Committee on Wednesday unanimously approved SB 1950.  Filed by Sen. Jason Brodeur, the bill maintains dental care as a separately procured service.

The House’s proposed bill also makes changes to what the health plans can consider as medical expenses when determining medical loss ratios. Medicaid managed care plans are currently allowed to include funds they spent on graduate medical education and residency programs training the state’s physician workforce.

The House bill proposes allowing health plans to include as medical expenses funds spent on training nurses and money spent for “student positions in any degree or technical program deemed a critical shortage area by the agency.”

The Senate version of the bill does not allow the expenses of the non-physician workforce to be included in a medical loss ratio.

The Senate and House bills both rearrange the number of Medicaid managed care regions, taking it down from the current 11 regions to eight.

While the reconfigured regions are the same in both bills, the House and Senate proposals differ on the number of plans in each region that the state must contract with.

The Senate has language that is not included in the House bill that alters how the state establishes the “achieved savings rebate.”