Payment failures to Florida’s sickest children could spur Medicaid managed care reform push

by | Feb 22, 2022

 

Software glitches that arose during the merger of the two largest Medicaid managed care providers in Florida are being blamed for payment stoppages to some of the state’s sickest children. But the political fallout from the payment failures could also be enough to spur state lawmakers into adopting wide-ranging changes to the state’s Medicaid managed care program  – and supporters say the changes are badly needed to help prevent future failures through increased competition.

The payment glitches, first reported last week, dragged on for three months and impacted tens of thousands of individual health care claims after the state’s largest payment vendors, Centene and Wellcare, encountered software compatibility problems resulting from their merger last October. The deal reduced competition and created a Medicaid payment juggernaut, but some Florida lawmakers think more competition, not less, is desperately needed.

And the clock is ticking.

If changes aren’t made during the 2022 Legislative Session, the state will be forced to stick with the current Medicaid structure for years to come. And some are concerned that a Senate bill, now in Appropriations, will only maintain the current status quo.

Tomorrow, the House Health and Human Services Committee will take up HB 7047, a reform bill that supporters say will increase competition between providers and give members more choice in their health care plans. The increased competition, supporters say, would go a long way toward improving quality of care and avoiding the types of problems that are slowing health care access for some patients – including the recent software glitch that inflicted Florida’s current payment system.

If passed, the House and the Senate would have to figure out how to merge the two bills together before the end of session.

Among the differences, the House bill also includes a prohibition on “auto-assignment,” which will prevent some of the larger managed care plans from getting even bigger. Under the current structure, if an eligible member doesn’t choose a plan, the system automatically assigns the member to a plan in the appropriate region in the state. But under the House proposal, auto-assignment to plans that have more than 45% of the region’s market share would be prohibited to avoid disproportionately inflating those larger plans even further.

Unlike the Senate version, the House bill also includes a dental carve-in, boosts the minimum number of allowed plans in three of the state’s regions, and requires providers to have a pre-existing contract to receive some federal dollars, including low-income pool payments.

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