Debate brewing on medicaid long-term care

TALLAHASSEE, Fla. – With a major nursing-home group looking for changes, a Senate panel Wednesday began delving into part of the Medicaid program that involves seniors enrolling in managed-care plans.

The Senate Health and Human Services Appropriations Subcommittee held a hearing two days after Senate President Joe Negron, R-Stuart, said he wants a review of the Medicaid long-term care system. Negron linked the review to the coming end of five-year contracts between the state and Medicaid managed-care plans.

Lawmakers in 2011 overhauled the Medicaid system to require most beneficiaries, including seniors needing long-term care, to enroll in HMOs or other types of managed-care plans. Part of the concept was that managed-care plans would provide a wide range of services that would allow Medicaid-eligible seniors to stay in their homes and communities rather than receiving costly nursing-home care.

Deborah Franklin, a nursing-home operator who represented the Florida Health Care Association at Wednesday's meeting, said the managed-care system works for seniors who can be served in their homes and communities or who need short-term rehabilitation in nursing homes. But the nursing-home industry group objects to the continued involvement of managed-care plans with people who are in nursing homes for long periods of time.

"(For people who stay in nursing homes for long periods), we don't believe the managed-care system is working properly, working effectively," Franklin said. "There are no savings associated with paying managed-care companies an administrative fee to manage for long-term care residents."

But the Florida Association of Health Plans, which represents managed-care companies, issued a statement after the meeting that indicated it does not think the Medicaid long-term care program should change. It pointed, in part, to cost savings from the program and the increased ability to provide home-based services to seniors and others who need care.

"FAHP (the Florida Association of Health Plans) supports keeping in place the current long-term managed care program that, as the Legislature originally envisioned, has proven successful at achieving cost savings and better serving a vulnerable population since its implementation," Audrey Brown, the group's president and CEO, said in the statement.

The state's shift to a Medicaid managed-care system was highly controversial when it was approved by lawmakers and Gov. Rick Scott in 2011. The managed-care program includes more than 3 million Medicaid beneficiaries, including about 94,000 people who need long-term care, according to information presented to senators Wednesday by Justin Senior, interim secretary of the state Agency for Health Care Administration.

Before moving to the Medicaid managed-care program, Florida relied on what is known as a "fee for service" system that involved more-direct payments to health providers. Critics argued, in part, that the old system was riddled with fraud and that care was fragmented.

Wednesday's hearing and Negron's comments indicate a debate could be looming in the 2017 legislative session, at least on the long-term care portion of Medicaid. During the meeting, senators also raised questions about issues such as whether managed-care plans are making timely payments to nursing homes and other service providers.

"As you can see, this is a pretty meaty issue with two ... different sides, and so we hope that we can provide some sort of dispute resolution," subcommittee Chairwoman Anitere Flores, R-Miami, said as Wednesday's hearing ended.