Enrollment in Florida MCO vs FFS reached 91.6% in 2021


Nicole Pasia


The number of individuals enrolled in Florida managed care organizations (MCO) reached an all-time high in 2021, according to a recent analysis by Health Management Associates Information Services. Over 4.1 million Floridians were enrolled in an MCO versus fee-for-service. Total Medicaid expenditures also surpassed previous years. 


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Florida implemented its Statewide Medicaid Managed Care (SMMC) program in 2013-2014 with two program components, the Medicaid Managed Care (MMC) program and the Long-Term Care (LTC) program. Data for 2014 shows 3,404,156 individuals were enrolled in Medicaid and Children’s Health Insurance Plan (CHIP). 3,037,382 of these enrollees, or 89.2%, were in an MCO. 

Total Medicaid expenditures in 2014 were $20.07 billion. About $7.43 billion, or 37%, of total expenditures were spent on managed care versus fee-for-service. 

From 2016-2018, overall Medicaid enrollment and MCO enrollment decreased by about 100,000-200,000 people. MCO enrollment during this period made up about 72% of total enrollment, compared to 90.7% in 2015. Total Medicaid expenditures gradually increased from 2015-2017, but the percentage of funds spent on managed care significantly increased from 37% in 2014 to 65.3% in 2015. 

The state’s first SMMC reprocurement in 2018 integrated MMC and LTC into one program and added a dental program. Enrollment dropped from 4,207,568 in 2018 to 3,615,005 in 2019, reflecting a nationwide trend. Possible factors that contributed to the decline include delays and errors in the redetermination process. The number of enrollees in MCOs during this period, however, increased from 3,037,660 (72.2%) in 2018 to 3,143,345 (87%) in 2019. 

Like other non-expansion states, Florida saw a significant increase in Medicaid enrollment during the COVID-19 pandemic. Nearly 500,000 individuals enrolled in Medicaid from 2019-2020, with another 400,000 enrolling from 2020-2021. The percentage of enrollees in managed care versus fee-for-service also increased from 87% in 2019 to 90.4% and 91.6% in 2020 and 2021, respectively. 

Medicaid expenditures increased by nearly $3 billion from 2020 to 2021, totaling $28.1 billion. About $20 billion, or 73.3%, was spent on managed care in 2021, second only to 2017, where 74.6% of funds were spent on managed care.