Christine Jordan Sexton
The state wants to test whether people with intellectual and developmental disabilities would be better served by a Medicaid managed care model.
Officials want to try out the idea in some of the most heavily populated regions of the state: Hillsborough and Miami-Dade counties.
The Agency for Health Care Administration (AHCA) is submitting a three-year waiver request to the Centers for Medicare and Medicaid Services (CMS) that, if approved, would authorize the state to develop what it’s calling the Comprehensive Intellectual and Developmental Disabilities Managed Care Pilot. According to the waiver it would launch Jan. 31, 2024.
Unlike other Medicaid managed care programs where enrollees have at least two managed care plans to choose from, AHCA is only required to contract with one plan, which means there is no choice of providers.
The pilot program is accepting up to 600 volunteer individuals with intellectual and developmental disabilities. It’s being launched in Medicaid Regions D and I. Region D consists of Hardee, Hillsborough, Highlands, Manatee and Polk counties. Region I is made up of Miami-Dade and Monroe counties.
The state Agency for Persons with Disabilities (APD) will choose the participants, all of whom must be at least 18 years old and on the waitlist for the state’s current Medicaid iBudget Waiver program.
The iBudget Waiver allows people with intellectual or developmental disabilities to obtain the types of home- and community-based services they require to live outside of an institution.
Those services, which can include help with dating and grooming, traditionally aren’t covered by Medicaid, which is why the state needed a waiver to provide the care.
APD has not publicly published updated data on the Medicaid iBudget waitlist since Nov. 1, 2022. According to that report, there were 22,535 people on the waitlist at the time. Roughly 36% had been on the waitlist for 10 years or more.
AHCA prepared the waiver request after the Legislature passed the pilot concept in SB 2510, a budget-conforming bill, and set aside funding for the program in the budget (SB 2500).
While SB 2510 authorizes the pilot in Medicaid Regions D and I, lawmakers only included funding in the Fiscal Year 2023-24 budget to test the program in Miami-Dade County, which is what the forces behind the idea, including Rep. Danny Perez, initially wanted.
Advocates, family members and caregivers have previously opposed efforts to require managed care for people with intellectual and developmental disabilities. Opponents have, in the past, successfully beat back efforts to require them to enroll in managed care plans.
Former APD Director turned lobbyist Jim DeBeaugrine noted that the 2023 Legislature agreed to test the idea before mandating it. He noted that only people who voluntarily agree to participate will be placed in the managed care plans.
But he cautioned that the population is “extremely vulnerable.”
“Changes can have severe impacts on people if they aren’t done properly, with a person-centered approach and with an eye on making sure everything in the system is driven by the needs of these individuals,” said DeBeaugrine, whose brother-in-law had Down syndrome. “So great care needs to be employed.”
DeBeaugrine said there also is a concern among advocates that the managed care plans could wipe out existing network infrastructure that, he said, “has emerged somewhat independently of what the government has done.”
Federal law requires the state to conduct a 30-day notice and comment period prior to submission of the waiver request. To that end, AHCA announced it would be accepting public comment on the waiver request through Aug. 27.
While lawmakers directed Medicaid officials to create the pilot program, it isn’t the only effort underway to enroll individuals with developmental and intellectual disabilities into managed care plans. Under the terms of the new Medicaid ITN, the state will assign individuals with intellectual or developmental disabilities into Medicaid managed care, although those individuals can opt out afterwards.
