The first Florida Medicaid patients required to join managed-care plans under the just-approved overhaul won't be the strong and healthy. The first wave will be made up of frail elders and the disabled.
Until now, Florida's plans to transfer Medicaid patients into managed care have focused on children and families, not the sick and frail elderly who need constant care. The assumption was that health maintenance organizations' complicated rules would trip up weak, confused elders.
But that thinking has changed. In the Medicaid overhaul that the Legislature passed and Gov. Rick Scott is expected to sign, the elderly and disabled would be the first group required to enroll in managed care.
If federal health officials approve the plan, in July 2012 the state will officially begin lining up HMOs and provider-service networks to take on the population beginning in October 2013.
Other Medicaid patients — mostly healthy children and pregnant women — won't have to enter a managed care organization until 2014, although they can enroll sooner if they want.
Medicaid experts say it's unusual to make frail elders go first. Consultant Brady Alexander of Tallahassee said he'll have to read the bills to be certain, but said he'd bet it's because the state desperately needs to curtail spending.
Old people are where the money goes in Medicaid. In Florida, where 30 percent of Medicaid patients are elderly or disabled, they accounted for almost 70 percent of spending in 2007, according to the web site State Health Facts.
A spokeswoman for House Speaker Dean Cannon offered two reasons for giving the elderly priority. First, said Katherine Betta, the potential for improved care in that population is great, by helping them stay independent and out of nursing homes as long as possible.
A state team will determine each patient's level of need. Level 1 Medicaid long-term-care patients must be in a nursing home. Level 2's have significant physical or mental impairment, but can still live in the community. Level 3's will be mildly impaired, physically or mentally.
The monthly premiums that the plans receive for the Level 2's would be greater than for the Level 3's. For the Level 1s — the nursing home patients — the state will require plans to pass on the full payment without taking part of it off the top.