In 2012, Floridians could see significant changes in the state’s Medicaid program that could impact vulnerable populations of concern to many grantmakers in Florida. These changes are part of an effort, begun in 2006, to move Florida Medicaid toward greater use of managed care with the stated goal of controlling costs.
For the past six years, experts at Georgetown University’s Health Policy Institute, supported by the Jessie Ball duPont Fund, have followed Florida Medicaid changes with a particular eye toward how these shifts are affecting, and will affect, the 3.1 million Floridians who rely on Medicaid for their health coverage.
In two recently-released educational briefs, also supported by the Winter Park Health Foundation, Georgetown researchers outline what changes may be on the horizon for 2012 and highlight particular concerns about a plan to impose broad-based fees on Medicaid beneficiaries.
Here is a quick look at the two briefs.
WHAT’S AHEAD IN 2012
In 2011, the Florida Legislature passed HB 7107 that called for major changes in Florida’s Medicaid program. Specifically, legislation would:
- Require the vast majority of Medicaid beneficiaries to enroll in managed-care programs for acute care rather than the traditional fee-for-service program.
- Require every Medicaid beneficiary – adults and children – regardless of age or income, to pay a $10 monthly premium and impose other fees.
- Require the majority of long-term care services to be delivered through managed care programs.
Because the federal government pays for more than half of the cost of Medicaid, states are not permitted to make certain substantive changes to the program without federal approval. States request changes by asking for “waivers.” At the start of 2012, Florida had multiple waiver requests pending before the federal Centers for Medicare & Medicaid Services (CMS), the agency that oversees these programs, to facilitate the changes called for in HB 7107.
Some advocacy groups oppose some of these changes, citing concerns about beneficiaries’ access to care and questions about whether the changes will actually save the state money. It is likely that CMS will require some modifications to the programs before the waivers are approved.
Change is not likely to come all at once, but incrementally, as some waiver requests are approved and others are renegotiated. But by year-end 2012, the Florida Medicaid landscape is likely to look quite different than it does today.
THE IMPACT OF THE MONTHLY PREMIUM REQUIREMENT
Under changes proposed for Florida’s Medicaid program, all beneficiaries – children and adults, regardless of age or income level – would be required to pay a $10 a month premium. While more than half of the states charge some form of fee or premium to Medicaid beneficiaries, Florida, if the proposal is approved, would be the only state to apply a premium this broadly to both children and adults.
Using scientific models developed by the Urban Institute, a nonpartisan economic and social policy research organization, Georgetown researchers calculated that the imposition of the $10 premium as proposed by the State of Florida would result in 807,000 fewer children and parents enrolling in Florida’s Medicaid program because of the cost.
Children will bear the brunt of the losses, largely because there are far more children than adults enrolled in Florida’s Medicaid program. More than 80 percent of those dropping coverage – about 663,000 – would be children.
Should this occur, it would likely blunt the success of Medicaid and CHIP in Florida in reducing the number of uninsured children to historically low levels. Florida’s children today are much less likely to be uninsured than adults, precisely because they have had Medicaid and CHIP to protect them from the decline in employer-based coverage and the rising costs of insurance.
- Mary Kress Littlepage, KBT & Associates, for the Jessie Ball duPont Fund and the Winter Park Health Foundation