Florida’s Senate Committee on Health Policy met earlier this week to discuss Medicaid redeterminations, which will take place starting in April. The committee also discussed the procurement process for Medicaid managed care plans since the current contracts expire on December 31st of 2024.
In Florida, Medicaid serves more than 5.5 million individuals, with about 25% of the state’s population on Medicaid, according to Tom Wallace, Deputy Secretary for Medicaid. Wallace presented information about the procurement process to the committee.
“The first five years of our Medicaid program were very successful,” Wallace said. “In negotiating the current six-year contracts, major additional improvements were achieved.”
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Statewide improvements include enhanced benefits, many of which are related to substance use disorder and mental health, and alternate pain management. In 2022, legislators passed House Bill 1950, which made changes to the statewide Medicaid managed care program (SMMC). The adjustments authorized the Medicaid agency to award contracts on both a regional and a statewide basis. Florida counties have also been realigned from 11 SMMC regions to nine regions, and there will be a single statewide procurement for Managed Medical Assistance (MMA), which provides preventative, acute, behavioral, and therapeutic services to recipients, and Long Term Care, which provides nursing facility level of care.
The Medicaid agency is currently going through the process of procurement for MMA and LTC contracts.
“I’m very sensitive to the procurement process and what you’re going through right now,” Sen. Bryan Avila (R – Miami-Dade) said. “Are there any possible hurdles, or any challenges you see that may be coming down the line with the implementation of this new procurement?”
While Wallace admitted his hesitancy to reveal too much information, he said the agency has seen gains in each procurement cycle they’ve undergone.
“The public health emergency has allowed all these additional Medicaid enrollment to just increase drastically here,” Wallace said. “And so our ability to properly review the income levels of our Medicaid population has come into play.”
Wallace described how the Medicaid agency strives to be good stewards of taxpayer dollars and that those who are no longer eligible should be pushed out of the program. According to Wallace, the Biden administration has prevented the agency from doing so under the Consolidated Appropriations Act, which brought protected measures for Medicaid that have been in place since the start of the COVID-19 pandemic.
Prior to the public health emergency, new individuals would hop on and off from the Medicaid program each month, but since the start of COVID-19, members have not been disenrolled.
“We have seen a pretty high increase in enrollment. Over 1.8 million additional recipients came into our program,” Wallace said, who was referring to enrollment from March 1st, 2020, through November 30th, 2022.
Casey Penn, assistant secretary for economic self-sufficiency with Florida’s Department of Children and Families, brought up how 900,000 members will not be eligible for Medicaid during redeterminations, but they will be prioritized.
“It doesn’t mean that 900,000 people are coming off of Medicaid in April,” Penn said. “There’s a process [through which] we go about doing this.”
About 850,000 individuals that the Medicaid agency has not yet heard from will be prioritized next. For this group, the focus is on spreading awareness about eligibility redeterminations and actions individuals need to take during the process. Penn suggests Medicaid recipients update their contact information. The final focus group will be the most vulnerable, such as children with complex medical conditions, because it gives the agency time to collaborate with the providers, according to Penn.
The Department of Children and Families conducts Medicaid eligibility for 4.7 million people out of the 5.5 million currently in the program.
“Has the income eligibility amount changed?” Sen. Rosalind Osgood (D – Broward) asked. “We’ve had a lot of changes in the economy—different things that happened—so if I was earning, let’s say $10,000 per year in 2020, I could potentially be earning $12,000 a year now. But, with all of the other cost of living adjustments, I could actually be in a deficit now and needing more help now than I did before the pandemic.”
Wallace and Penn reassured Osgood that the federal cost of living adjustment will be applied to current Medicaid eligibility standards. Leading up to redeterminations, the Department of Children and Families and the Medicaid agency will conduct extensive outreach to make sure individuals are prepared for a potential change of circumstances, and to ensure they have access to the services and resources they require if they no longer qualify for Medicaid.