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Evaluating Medicaid Reform in Florida

Effective July 1, 2006, AHCA began implementing Medicaid Reform in Broward and Duval Counties. Broward County is located in the southeast section of Florida and includes the city of Fort Lauderdale. Duval County is located in the northeast section of Florida and includes the city of Jacksonville. Beginning in July 2007, Medicaid Reform was expanded to Baker, Clay, and Nassau Counties, all of which are somewhat more sparsely populated counties with extensive rural areas. All are in northeast Florida, adjacent to Duval County. Enrollment for the expansion counties began in September 2007. The Reforms will then be phased in statewide, again dependent on legislative approval.

Evaluating Medicaid Reform in Florida Project Description provides a detailed description of each sub-project including research questions, hypotheses, data elements, and data sources.

As envisioned by those responsible for designing and implementing the changes, Medicaid Reform will transform Florida’s Medicaid program by empowering consumers to take control of their health care, providing more choices for consumers, and enhancing the health status of Medicaid enrollees through increased health literacy and incentives to engage in healthy behaviors. The expressed principles governing Medicaid Reform are

  • • patient responsibility and empowerment,
  • • marketplace decisions,
  • • bridging public and private coverage, and
  • • sustainable growth rate.

Some of the key features of the Reform process are:

1. Customized benefits package-Reform Health Plans can design their own benefits package, subject to tests of actuarial equivalency and benefit sufficiency. After plans are approved by AHCA, enrollees are able to choose the plan best suited to their specific needs.

2. Choice Counseling-Choice Counseling is a comprehensive counseling program designed to provide the education and outreach necessary to assist Medicaid enrollees in making a health plan choice that best fits their specific needs. Choice Counselors also provide information aimed at enhancing health literacy and the promotion of healthy lifestyles in order to reduce minority health disparities.

3. Enhanced Benefits Account-Enrollees are offered incentives to participate in wellness programs. Once the enrollees satisfy all the requirements, funds are placed in their accounts which can be utilized for purchasing certain over-the-counter items at any Florida Medicaid participating pharmacy.

4. Opt Out-Enrollees have the option to opt-out of the Medicaid program at any time, and enroll in private Employer Sponsored Insurance (ESI). The State will provide the employee share of health insurance premiums, not to exceed the Medicaid authorized premium.

The MRE Team will examine the evolution of Florida’s current Medicaid Reform initiative, beginning with the earliest expressions of interest through the initial legislation, the Waiver application, the subsequent legislation, program design, implementation, and outcomes. The MRE Team will pursue its analysis through inquiry in four major project areas: (1) organizational analyses; (2) quality of care, outcomes, and enrollee experience analyses; (3) fiscal analyses; and (4) analysis of the Low-Income Pool.

Evaluating Medicaid Reform in Florida Project Description provides a detailed description of each sub-project including research questions, hypotheses, data elements, and data sources. [link pdf to underlined document name. Will send when finalized]

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Evaluating Medicaid Reform in Florida

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