Christine Jordan Sexton
A Florida nursing home organization wants to see changes made to the statewide Medicaid managed care program.
Tony Marshall, director of reimbursement for the Florida Health Care Association, said his group would like to modify the program so patients who use long term care services can have the same managed care plan for their traditional health care needs.
There are about 85,000 patients enrolled in the managed long term care program. Many of them, Marshall said, are required to select more than one managed care plan: one for their long term care needs and the other for their traditional health care needs.
The use of separate plans is confusing to residents, many of whom suffer from some form of dementia, and can result in lack of coordination of are. Separate plans also means that there are two separate case managers for each resident, Marshall told participants at the 2015 Health Care Affordability Summit hosted by the Foundation for Associated Industries of Florida.
Marshall said a real problem is occurring with transportation. Often times, he said, a car or a cab arrives to transport a patient to the doctor but the patients needs transportation that can accommodate stretchers.
There are roughly 85,000 enrollees in the Statewide Medicaid Managed Care long term care plan. Forty three percent of them reside in nursing homes and another 47 percent are in home and community based waivers. The other 10 percent move between the two programs.
The Agency for Health Care Administration in 2012-13 awarded seven managed long term care companies contracts to care for Medicaid long term care patients In 2013 AHCA awarded 14 Medicaid managed care plans contracts to care for traditional Medicaid services. Patients who reside in areas where the same managed care plan was selected for each program are not required to have two Medicaid plans.
FHCA says the rub occurs when a patient resides in an areas where two plans are required. In those instances, Marshall said, the FHCA would would like patients to have the ability to select a long term care plan that could provide a comprehensive set of benefits.
“The fix from our perspective is to allow the long term care plans to provide comprehensive Medicaid services to all of the residents enrolled in their plan,” said Marshall. “This is the most important issue to help ensure our residents are receiving appropriate access to Medicaid services.”
