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State
outlines improvements to healthcare system for
Florida's most vulnerable citizens
TALLAHASSEE - Governor
Jeb Bush today announced the online publication of Florida's application
for a waiver from the Federal Government to transform Medicaid, the
state federal partnership charged with providing healthcare to more
than 2.1 million vulnerable, disabled and elderly Floridians. The
plan, detailed in the application, reinvents the program to look and
operate more like a private health care market. Florida will submit
the application to the Federal Centers for Medicare and Medicaid Services
(CMS) in thirty days.
"The goal of Medicaid
reform is improving the quality of healthcare for our most vulnerable
citizens," said Governor Bush. "This plan maintains the
same eligibility requirements as the current program, but empowers
patients to direct their own healthcare, encourages stronger doctor-patient
relationship, expands access and increases choices."
The plan responds to suggestions from Medicaid participants, legislators,
stakeholders, community leaders, providers and advocates collected
during the last six months by the Agency for Health Care Administration
(AHCA).
Under the law (Senate
Bill 838) authorizing a statewide reform of Medicaid, Florida is required
to post the application online for 30 days before submitting it to
the Federal Centers for Medicare and Medicaid Services (CMS) for approval.
Following approval from CMS, the Florida Legislature will review the
reform plan before its first phase is implemented in Duval and Broward
counties in spring 2006.
"The current fractured,
fee-for-service system doesn't come close to meeting the needs of
Florida's Medicaid participants," said AHCA Secretary Alan Levine.
"By reforming Medicaid, we'll create a system that provides quality
care to those who need it most and bring predictability to spending
to ensure the program is sustainable over the long -term."
Medicaid has not undergone
significant reform since its inception more than 30 years ago. A reformed
Medicaid will bring predictability to state spending on Florida's
rapidly growing $15 billion program. If Florida's Medicaid program
continues to grow at its present rate, it will consume nearly 60 percent
of the state's budget by 2015.
Guiding principles of
the plan to transform Medicaid include:
* Moving To a Patient-Centered
System
* Customizing benefit
packages will allow health plans meet the unique needs of participants.
Participants will be able to choose among a variety of benefit packages,
and with the help of independent choice counselors, will choose the
plan that best meets their needs.
* Transparency among
plans will be critical in empowering consumers. All plans will be
required to collect and report information such as consumer satisfaction,
percentage of children who receive annual physicals and preventive
dental care, and waiting times for customer assistance, among other
measures.
* Medicaid participants
will also be able to opt-out of Medicaid entirely and use their state-allocated
Medicaid premium to participate in an employer-sponsored plan.
* By engaging in healthy
behaviors, participants can earn credits for approved health related
expenses like co-pays, over-the-counter medications or eyeglasses.
These incentives will encourage participants to engage in healthy
lifestyle choices - improving health outcomes and lowering acute care
costs - while providing a means to access health items not covered
by Medicaid.
Creating a Medicaid Marketplace:
* Under a reformed system,
provider groups will have greatly improved flexibility in forming
and designing benefit plans with strict oversight from the state.
Providers will attract membership on the basis of their benefit package,
innovative care, convenient networks, and optional services. The consumer
satisfaction data collected by the state will drive quality of care
and allow participants to make informed choices about the plan that
best fits their needs.
* Each plan will be measured
on quality, giving policymakers best practices to continually improve
healthcare for Florida's Medicaid participants. With half of Florida's
Medicaid population comprised by African American and Hispanic participants,
this information is important to help close the gap of racial disparities.
* Market forces will
reduce fraud in Medicaid. Because the current Medicaid system pays
claims first and identifies fraud later, there is virtually no certain
way to control fraud and abuse. Under proposed reforms, health plans
have a financial incentive to aggressively guard against fraud. Plans
will be required to report overpayments to the state and will be able
to identify fraudulent providers within their networks.
For more information,
and to read the Florida Medicaid waiver application in its entirety,
please visit http://ahca.myflorida.com.
