Florida

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Section 1115 Demonstration Waiver

On July 31, 2014, CMS approved Florida to continue its §1115 Managed Medical Assistance (MMA) demonstration waiver through June 30, 2017. The waiver was initially approved in 2005. Under the demonstration, managed care participation is mandatory for TANF-related populations and the Aged and Disabled group, as well as individuals eligible for both Medicare and Medicaid. The following populations may choose to be participants in the managed care demonstration: Individuals who have other creditable health care coverage, excluding Medicare; individuals age 65 and over residing in a mental health treatment facility meeting the Medicare conditions of participation for a hospital or nursing facility; individuals in an intermediate care facility for ID; individuals with DD enrolled in the HCBS waiver pursuant to state law; and Medicaid recipients waiting for waiver services. (Source: Medicaid.gov)
Approval Letter (7/31/2014)
Fact Sheet (7/31/2014)

On October 8, 2014, the Florida chapter of the American Academy of Pediatrics sent a letter to the secretaries of the Florida Department of Health and the Agency for Health Care Administration requesting urgent, face-to-face talks about barriers to care for medically fragile children related to the state’s rollout of its Managed Medicaid Assistance (MMA) program.  The MMA program requires nearly all of the 3.6 million Floridians on Medicaid to be enrolled in managed care plans.  Under the program, medically fragile children were supposed to be able to continue seeing their current doctors through the Children’s Medical Services (CMS) program; however, some families of CMS recipients were mistakenly told that they had to switch to a private plan, thereby dropping some CMS patients from their doctors’ network.  (Source:  Health News Florida, 10/16/2014; HMA Weekly Roundup, 10/22/2014)

On March 27, 2015, the Florida Agency for Health Care Administration (AHCA) posted its draft §1115 Medical Managed Assistance (MMA) Waiver Amendment Request, along with a Public Notice of two April meetings to solicit public input about the waiver amendment request.  The state is seeking the waiver amendment to change the auto-assignment criteria and remove the 30-day wait period between eligibility determination and managed care plan enrollment.  (Source: Link no longer available)

On August 3, 2017, the Centers for Medicare & Medicaid Services (CMS) approved Florida’s section 1115 waiver—Managed Medical Assistance Program (MMA)—renewal application. The new demonstration period runs from August 3, 2017, through June 30, 2022. CMS also established the state’s low-income pool (LIP) uncompensated care allotment, which is set at $1.5 billion annually. (Source: Waiver Approval Letter 8/3/2017) 

Medicaid Managed LTSS Program & State Initiative to Integrate Care for Dual Eligible Individuals

The Florida Long-Term Care Community Diversion Program, operating under §1915(a) and §1915(c) waiver authorities, provided community-based services to people who would otherwise qualify for Medicaid nursing home placement. The LTC Community Diversion Program was phased out in 2014. (Source:  Department of Elder Affairs Medicaid Waiver Programs WebsiteApproved Waiver)

The 2011 Florida Legislature passed HB 7107 which directed the state to restructure its Medicaid program into an integrated managed care program requiring almost all Medicaid recipients (including TANF, SSI and duals) to receive covered services through the Statewide Medicaid Managed Care (SMMC) program. In August 2011, in accordance with this legislation, the state submitted to CMS concurrent §1915(b) and §1915(c) waiver applications to implement the Florida Long Term Care Managed Care Program. (Source: Florida Long-Term Care Managed Care Program Website; CMS and Truven Health Analytics, 7/2012; HMA Weekly Roundup, 6/4/2014)
§1915(b) waiver application
§1915(c) waiver application

In February 2013, CMS approved the state’s §1915(b)(c) Florida Long Term Care Managed Care Program combination waiver, effective July 1, 2013 through June 30, 2016. From August 2013 through March 2014, the state regionally phased out five of its current HCBS waivers and transitioned eligible recipients from its LTC Community Diversion Program into its new Statewide Medicaid Managed Care Long-Term Care Program. Mandatory enrollment populations include dual eligibles (under fee-for-service). (Source: Department of Elder Affairs Medicaid Waiver Programs Website; Florida Long-Term Care Managed Care Program Website)
Approval letter (2/1/2013)
A Snapshot of the Florida Medicaid Long-term Care Program (2/18/2014)

On July 1, 2014, Florida began offering a Medicaid managed health plan designed exclusively for people with serious mental illness.  The plan, offered by Magellan Complete Care, is part of a wave of state experimentation to coordinate physical and mental health care for those enrolled in Medicaid.  About 140,000 low-income Floridians are likely to be eligible, and Magellan predicts about 20,000 will participate voluntarily in the first year.  Medicaid recipients who meet the plan's criteria will automatically be assigned to it by the state, with the option to opt into a different managed care plan within 90 days of enrollment.  Coverage began July 1 in Miami-Dade and Broward counties and will roll out to other regions by September 2014.  (Source: Pensacola News Journal, 7/5/2014; HMA Weekly Roundup, 7/9/2014)

On July 14, 2014, the state announced all individuals with critical needs who have been on the Agency for Persons with Disabilities (APD) waiting list as of July 1, 2014 will be offered enrollment in the HCBS Medicaid Waiver.  (Source: State APD News Release, 7/14/2014)

On January 7, 2016, the Florida Agency for Health Care Administration (AHCA) released information that long-term care beneificiaries are reporting the greatest improvement in quality of life in the agency's history. For example, over 77 percent of enrollees in the state's Long Term Care plan report improvement in their quality of life. (Source: Link no longer available 1/7/2016)

The Florida Agency for Health Care Administration recently completed a public comment period on a draft application to renew Florida’s Long-term Care 1915(c) waiver, with an effective date of July 1, 2016. Comments on the application were due by May 27, 2016. Alterations to the Long-Term Care Waiver in the application, which authorizes LTSS benefits under the State’s MLTSS program, include:

  • Revising case management provider qualifications;
  • Revising performance measures;
  • Updating spousal impoverishment policy;
  • Updating the personal needs allowance description;
  • Updating physical therapy requirements;
  • Removal of the structured family caregiver service;
  • Updating the waiver’s home and community-based settings transition plan; and
  • Updating the unduplicated enrollee numbers and related cost projections. (Source:  AHCA Website 4/28/2016; Draft Application)

On November 8, 2016, the Herald Tribune reported that the Florida Agency for Health Care Administration (AHCA) will submit a proposal to extend the state’s managed long term services and supports (MLTSS) program to the Centers for Medicaid & Medicaid Services (CMS) following the closing of the state’s public comment period on November 10, 2016. The proposal would extend the state’s Medicaid managed care waiver through 2020. (Source: Herald Tribune 11/8/2016)

On December 13, 2016, Health News Florida reported that Florida’s Senate President is interested in reviewing Florida’s MLTSS program. The interest comes as Florida is nearing the end of the state’s five-year MLTSS contracts with managed care organizations (MCOs), and there has been pushback from the state’s nursing home lobby on renewing mandatory managed care enrollment for individuals residing in nursing facilities. Currently, Florida has over 3 million Medicaid beneficiaries enrolled in managed care, 94,000 of which have LTSS needs.  (Source: Health News Florida 12/13/2016;  News4Jax 12/14/2016)

On December 30, 2016, the Florida Agency for Health Care Administration (AHCA) submitted an application to extend the state’s section 1115 waiver, which includes MLTSS in the state. The extension period would be from July 1, 2017 – June 30, 2022. According to AHCA, the managed care waiver has succeeded in improving health outcomes for Floridian Medicaid beneficiaries, while helping to control costs. (Source: Florida Politics 12/30/2016) 

On January 10, 2017, News4Jax reported that the Florida Health Care Association, which represents nursing facilities in the state, is continuing to push the state to carve out certain older adults from MLTSS—namely, older adults with extended stays in nursing facilities. The nursing home lobby asserts that the state is needlessly paying MCOs an administrative fee to manage beneficiary care but they are not getting any extra services or care because they are in a nursing facility. The state disagrees, however, and an official from AHCA noted the state is committed to keeping the continuum of care needs under a managed care system, and that they have seen many cases of long-term residents of facilities returning home and being successfully cared for in the community. (Source: News4Jax 1/10/2017)

Florida’s Agency for Health Care Administration (AHCA) has released a list of companies that submitted non-binding letters of intent to bid on the state’s upcoming Medicaid managed care reprocurement. Included on the list are major Medicaid managed care players such as Amerigroup, Aetna, Humana, Molina Healthcare, United Healthcare, and WellCare, as well a plethora of smaller entities. (Source: AHCA List 2/13/2017)

On March 21, 2017, Florida Politics reported that an analysis conducted by AHCA on a proposed bill (SB 682) that would carve out nursing facilities from the states’ Medicaid managed care program, found that it would add an additional $200 million to the state’s annual operating costs. This is largely due to the fact that MCOs in Florida have been successful at transferring and keeping members in their homes and communities, which is cheaper than institutional care received in a facility, such as a nursing home. (Source: Florida Politics 3/21/2017)

On April 18, 2017, the Palm Beach Post reported on a bill that passed the Florida House Health Care Appropriations Subcommittee that includes a change to financing for the state’s MLTSS program. Currently, the Agency for Health Care Administration (AHCA) defines payment rates for each nursing facility. However, HB 7117, if implemented, would change the law to have nursing facilities and managed care plans negotiate over their payment rates as opposed to having them set by the state. The move is opposed by the states’ nursing home lobby. (Source: PalmBeachPost.com 4/18/2017; HB 7117 Text 5/1/2017)

On May 8, 2017, the Florida legislature ended its legislative session with the passage of an $82.4 billion dollar budget. The budget and related health care amendment contained the following changes that may impact the states’ MLTSS program:

  • The Agency for Healthcare Administration (AHCA) is instructed to establish a working group to analyze instituting a prospective payment system for nursing homes. The work group is to submit a report by December 1, 2017, with hopes of implanting a PPS system by October 1, 2018.
  • Florida will aim to enroll individuals with cystic fibrosis that qualify for hospital care to be enrolled into MLTSS, and also – pending Federal approval – requiring enrollees in the states Traumatic Brain and Spinal Cord Injury Waiver, the Adult Cystic Fibrosis Waiver, and the Project AIDS Care Waiver to be carved into MLTSS on January 1, 2018.

The budget did not, however, contain language that was included in HB 7117 that would have required nursing homes and managed LTC plans to negotiate over payment rates. (Source: SB 2514 5/8/2017) 

On June 22, 2017, Florida Politics reported that the Agency for Health Care Administration (AHCA) would post materials for the next re-procurement of the Statewide Medicaid Managed Care (SMMC) program in mid-July. Upon publication of the materials, the State would initiate its Invitation to Negotiate (ITN) process for interested parties, which is the Florida MCO procurement process. (Source: Florida Politics 6/22/2017) 

On July 14, 2017, the Florida AHCA released the ITN to re-procure its MCOs for the SMMC, which includes MLTSS. The SMMC has two major programs: the Managed Medical Assistance (MMA), and Long-term Care (LTC). Potential respondents may submit a response for the following plan types: Comprehensive Long-term Care Plan, Managed Medical Assistance (MMA) Plan, Long-term Care Plus Plan (LTC), or a Specialty plan. Interested parties are able to submit additional Specialty plan responses broken out by target population. 

  • Comprehensive LTC Plan - as an MCO that is able to provide both MMA and LTC services to elgiible beneficiaries.
  • LTC Plus Plan - an MCO that is able to provide MMA services and LTSS to recipients enrolled in the LTC program; not eligible to serve recipients who are only eligible for MMA services. 
  • Managed Medical Assistance Plan - an MCO that provides MMA services only and does not serve recipients eligible for LTSS. 
  • Specialty Plan - provides MMA services to specialty populations as defined by the contract. 

Florida’s SMCC program covers over 3.2 million people, and has estimated spending of $18.4 billion. Under this current procurement, in addition to the core requirements, AHCA is looking for health plans that offer innovative approaches in the following areas: 

  • Reducing preventable hospitalizations and unnecessary service use; 
  • Improving birth outcomes; and 
  • Continuing to rebalance the states' LTSS system away from institutions and towards more community-based care. 

Responses to the ITN are due by November 1, 2017, at 9:00 a.m. Bidders may submit proposals for both statewide or regional contracts. The anticipated notice of intent to award is April 16, 2018. The term of the contracts is from the date of execution of the contract through September 30, 2023. (Source: : Invitation to Negotiate 7/14/2017; HMA Weekly Roundup 7/19/2017)

On October 6, 2017, a bill was filed in the Florida Senate that would create a Florida Veterans Care Program. The bill, SB 440, would create the Florida Veterans Care Program within the Agency for Health Care Administration (AHCA), which would utilize the state’s Medicaid managed care system to serve eligible veterans who choose to opt-in to the program. The bill would instruct AHCA to negotiate with relevant federal agencies to pursue a waiver that would allow implementation of the program, and doing so only utilizing federal funds; state funds are prohibited from being used for the program. If implemented, eligible veterans would receive all medical and LTSS services through the Medicaid managed care, including HCBS. The bill would not affect individuals’ eligibility for the state’s Medicaid program. If the bill passes the legislature, and AHCA was able to secure a waiver, the program would go into effect July 1, 2018. On November 7, 2017, SB 440 was unanimously approved by the Senate Health Policy Committee (Source: SB 440 10/6/2017; News4Jax 11/7/2017)

On October 11, 2017, CBS Miami reported that Florida’s AHCA has increased rates paid to MCOs managing LTSS in the state’s Medicaid program by 2.4 percent. AHCA is reducing rates for other MCOs not responsible for LTSS by 3.7 percent. The state recently added approximately 14,000 individuals into its MLTSS program, bringing the total to over 98,000 enrollees. Florida is currently undertaking a re-procurement of its Medicaid managed care program. (Source: CBS Miami 10/11/2017)

On November 2, 2017, AHCA released the list of respondents to the state’s invitation to negotiate (ITN) that was released this past July regarding the re-procurement of its statewide Medicaid managed care program. Respondents included: Clear Health Alliance; Aetna Better Health of Florida; Florida Community Care; Coral Care; Magellan Complete Care; Prestige Health Choice Florida; Humana Medical Plan; Health Advantage Florida; Lighthouse Health Plan; Molina Healthcare of Florida; Miami Children’s Health Plan; Our Children PSN of Florida; Simply Healthcare Plans; Sunshine State Health Plan (Centene); UnitedHealthcare of Florida; and Staywell Health Plan of Florida (WellCare). (Source: ITN Respondents 11/2/2017)

Section 1915(i) HCBS State Plan Option

As of May 2014, CMS has approved the state’s §1915(i) HCBS State Plan Amendment; and the state is currently participating in the HCBS State Plan Option. (Source: Kaiser HCBS State Plan Option website, 5/2014)