Florida: State begins shift to Medicaid managed care

Monday, September 24, 2012

TALLAHASSEE, Fla. – Florida has put its Medicaid business out to bid, and HME providers here say that could create opportunity for new business.

The state plans to shift from its current fee-for-service program to a statewide Medicaid managed care program in which insurers will bid for contracts to manage patient care. Insurers will bid in 11 regions, with more contracts awarded in more populated areas.

“It will affect HME providers because the Medicaid population will likely be expanding,” said Sean Schwinghammer, former executive director of the Florida Association of Home Care Services. “The entire premise of Medicaid reform is to move patients into home-based care and they’ll need HME.”

Once the state awards the contracts, it will begin rolling out the program in certain areas of the state, likely in January 2013. The process will start with long-term care contracts, but it is expected that everyone will eventually be impacted, say stakeholders.

While there’s an opportunity for increased Medicaid business, providers worry they will be shut out of the insurance networks—despite a law that includes an any-willing provider provision. 

“The thing with the HMOs, they want to (work) with one company and let that one company handle everything,” said Fino Randazzo, owner of Florida Home Health in Orlando. “It monopolizes the whole system and it doesn’t allow the little mom and pops.”

The insurance companies, for their part, have been meeting with different healthcare providers to discuss the shift to managed care and find provider partners.

“It’s good and bad,” said Rob Brant, CEO of the Accredited Medical Equipment Providers of America. “Fee for service is going to end, but there is an opportunity to get tied in with these different insurance networks.”