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Medicaid long-term care plans are changing

SEBRING - Highlands County Medicaid recipients will change to a managed-care plan - some on Feb. 1, some later this year.

Since the Agency for Health Care Administration's second and final rollout of the Statewide Medicaid Managed Care program went live on Aug. 1, the long-term care program has transitioned more than 50,000 recipients from fee-for-service to a managed care delivery system.

"We look forward to having the last few regions go live in early 2014 with the same results," said AHCA Secretary Liz Dudek. Highlands County is in that final region.

Recipients on long-term care have already received several letters, said Deputy Secretary for Medicaid Justin Senior. Medicaid recipients on other plans will transition later this year.

The long-term care plan is for nursing home patients, and the frail and elderly who receive home health services, Senior said.

Doctors and health-care providers have also received bulletins. If there is a question about which group a Medicaid patient falls into, providers have been assured they will be paid either way, Senior said.

"These mailings will inform them of the plans available in their area, and outline all of the features to be considered when making a plan selection," Dudek said.

Some Medicaid recipients will see no changes at all, Senior said. "A nursing home is managed care."

Others may have to switch their long-term care plan, and providers may have to sign new contracts. "We hope that they get is a lot better continuity of care," Senior said. If that's true, they will receive "better outcomes on the Medicare side."

"It may help get people out of a nursing facility, if it's safe, and they'll be served in a home and community settings, the way they prefer to be served. And it's a lower cost setting,"

That helps the government because the program "has more predictable costs," said Sen. Denise Grimsley, R-Sebring.

Medicaid is financed by federal tax dollars, Senior said. "So it not only saves money, it provides richer service package."

Democrats and other critics have said the new system is "plagued with problems," and have suggested that managed care companies will make their money by reducing services.

"Not just Democrats," said Grimsley, who is a registered nurse. "Many of us said that about the old system, and that is why we implemented reforms."

Even better, some adult Medicaid patients will receive dental services, Grimsley pointed out. "Adult recipients never had that service before."

"If there is a reduction in services, (recipients) can challenge them through a fair hearing process," Senior said.

Payments to doctors are already so small that Medicaid patients struggle to find doctors, Dr. Mathis Becker, president of the Hillsborough County Medical Association, told the Tampa Bay Times.

"The planned reform is not going to solve this issue and indeed may intensify it," Becker said, "because it will empower those Medicaid managed care companies to put on pressure to negotiate for even lower fees for physicians."

"If folks get the right service at the right place at the right time," Senior responded, "it will increase reimbursement to doctors."

After receiving a welcome packet, recipients can contact the agency's choice counseling vendor, either online or over the phone, to select their plan, or meet face-to-face.

The choice counseling website is www.flmedicaidmanagedcare.com and the phone numbers are (877) 711-3662 or (866) 467-4970 for TDD.