Changes coming to Medicaid managed care

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NEWS SERVICE OF FLORIDA

As the number of Floridians relying on Medicaid for health care climbs, the state is moving to change a rule about disenrollment and when people can request to be switched to different managed care plans.

The state Agency for Health Care Administration announced Monday its intent to change a rule to “clarify reasons an enrollee may request to change managed care plans.”

A workshop on the proposed changes has been scheduled for Aug. 17. The current rule allows disenrollment for good cause and lays out a series of qualifying reasons, including when a patient is receiving a medically necessary, active and continuing course of treatment from a provider that is not in the managed care plan’s network but is in a different plan’s network.

13 care companies

Patients who would have to switch residential or institutional providers due to changes in plans’ networks also can qualify for good cause. Florida had more than 4.1 million people enrolled in Medicaid as of June 30, the latest available data.

The number has been increasing because of job losses and other economic fallout from the coronavirus pandemic. Most Medicaid beneficiaries – 3.2 million – are in managed care plans as a result of a law that instituted a statewide managedcare system.

The state has contracts with 13 managed care companies to offer health services to poor, elderly, and disabled residents. The state also has contracts with five managed care plans to provide specialty services – such as mental-health services, care for people with HIV and AIDS and care to children with chronic medical conditions – and contracts with three managed dental-care companies.

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