Policy Engagement - Medicaid



Medicaid Reform

Substantial changes to Florida’s Medicaid program were allowed by a federal Medicaid Section 1115 waiver approved on October 2005. In July 2006, Florida launched Medicaid reform pilots in Broward and Duval counties. A short year later, the pilots were expanded into Baker, Clay, and Nassau counties, mainly rural counties. The purpose was to implement a comprehensive demonstration designed to improve the value of the Medicaid delivery system by coupling the increased use of managed care principles with innovative approaches like customized benefit packages, opt-out provisions, and health-related incentives or enhanced benefits for beneficiaries.


In 2007, Health Foundation awarded a $50,000 grant to Human Services Coalition and Florida CHAIN to begin to look at consumer experiences with Medicaid Reform in Broward County. After conducting focus groups, town hall meetings, community forums and key stakeholder interviews the conclusion was that Medicaid Reform had not been a positive experience for Broward County enrollees. In 2010, the Foundation commissioned a report from the Department of Health Services Research, Management and Policy at University of Florida to evaluate physicians’ perspectives and experiences with Medicaid Reform in Broward County. The report titled “Medicaid Reform: Broward County Physicians’ Experiences” was shared with elected officials and can be accessed here.


Despite limited evidence that the Medicaid pilot has reduced costs or improved quality of care, in May 2011, the Florida legislature passed a bill which would move the vast majority of Medicaid beneficiaries into capitated managed care. Furthermore, it would also expand the pilot statewide. Other potential changes establishing a $10 monthly premium regardless of income or age which, if implemented, could result in major declines in enrollment.


Other issues of interest in the Medicaid discussion includes the medical loss ratio (MLR) and Low Income Pool (LIP) which has been providing Florida with an additional $1 billion annually to compensate providers who see a large volume of uninsured patients. The state’s request to exempt Florida insurers from the MLR requirement, created by the Affordable Care Act, was recently rejected. Department of Health and Human Services denied the State’s request for a partial exemption from the MLR provision clearing the way for Florida health care consumers to benefit from more than $140 million in rebates from insurance companies over the next three years. This was a great victory for consumer advocates. On the other hand, the LIP funding has been approved but with requirements that involve the need for hospitals to implement programs to improve quality of care for their patients. 


Health Foundation remains committed to working with community partners in creating a sustainable, high-quality Medicaid program.





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