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September 08, 2014

Most Medicaid recipients transitioned to managed care

After experimenting since 2005 with managed care models for Medicaid recipients, Florida is transitioning nearly all its 3.6 million recipients into managed care plans. The effort, lawmakers believe, will cut costs. The rollout process, staggered across the state’s 11 Medicaid districts and managed by the Agency for Health Care Administration, is expected to be completed in August.

Some of you may receive questions about this, because over the last several months, state authorities have been mailing welcome letters informing Medicaid recipients about their choices. Recipients are matched with an available plan that appears to best meet their medical needs and can choose the plan suggested or may choose from a list of other plans available in his or her district. Specialty plans are available for patients with qualifying distinct diagnoses and/or chronic conditions.

Nearly all of Florida’s Medicaid recipients will be moved in phases to private insurers. Most recipients are required to choose from a list of available managed care organizations—generally HMOs and Provider Service Networks (PSNs)—that meet state-mandated minimum standards of coverage; many of the plans cover additional services.

The new system, called Statewide Medicaid Managed Care (SMMC) uses a capitation model in which managed care companies receive a flat fee for each participant enrolled. Medicaid recipients have 30 to 60 days to finalize their plan selection. There’s also a 90-day grace period in which recipients may revise their selection if they wish.

Choice counselors are available to guide Medicaid recipients through the plans available in each district. Recipients can receive guidance and make their selections by phone, in person or at the program’s counseling website.

For eligibility and participation requirements, covered benefits and provider details, click here. More information is available at the SMMC website.


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