Florida Medicaid Reform
Medicaid is the principal state and federal program that finances the health and medical care of low-income families, the elderly, and people with disabilities who meet eligibility requirements, do not have health insurance, and otherwise cannot pay for their health care. Florida’s Medicaid program, implemented on January 1, 1970, was modeled after the healthcare financing and delivery of the private sector at that time. However, the healthcare market in which Medicaid operates has experienced dramatic changes since the program’s creation almost four decades ago, and the needs of the population it serves are constantly evolving. Medicaid has grown to become the single largest healthcare program in the United States. In Fiscal Year (FY) 2005, Medicaid served 52 million people in the U.S., with expenditures of $320 billion.1 In Florida FY 2005, Medicaid served 2.2 million people,2 with expenditures of approximately $13.4 billion.3 Florida Medicaid offers more than 47 different service types in its benefit packages through 91 separate contract organizations and almost 70,000 participating providers, and the program operates within the parameters of 20 different federal waivers.4
As a state, Florida has a significant history of making changes to its Medicaid program. The changes have varied in scope, intensity, and results, including the degree to which those results are fully documented and understood. Some have been described in detail,5 others are ongoing, and some have effectively been forgotten. However, each of these prior initiatives had its origin in an idea or cluster of ideas about how Medicaid might be improved. That is certainly the case in Florida’s current Medicaid Reform initiative.
On May 6, 2005, the Florida Legislature authorized Medicaid Reform in Senate Bill 838. In accordance with Senate Bill 838, Florida’s Agency for Health Care Administration (AHCA) formally submitted an application for an 1115 Research and Demonstration Waiver to the U.S. Department of Health and Human Service’s Centers for Medicare and Medicaid Services (CMS) on October 3, 2005. That application was approved by CMS on October 19, 2005. On December 8, 2005, the Florida legislature passed legislation (House Bill 3B) to authorize the design and implementation of the reforms described in the Waiver Application.6
For more information please visit the Florida Agency for Health Care Administration’s (AHCA) Medicaid Reform website at: http://ahca.myflorida.com/Medicaid/medicaid_reform/index.shtml
1 Ryan, Jennifer. (March 2006). National Health Policy Forum. Issue Brief-No. 810. Medicaid in 2006: A Trip Down the Yellow Brick Road?
2 Ellis, E. R., Smith, V. K., & Rousseau, D. M., Schwartz, K. (2006). Medicaid enrollment in 50 states: June 2005 data update. Available from the Kaiser Commission on Medicaid and the Uninsured website, http://www.kff.org/medicaid/7349.cfm
3 The Kaiser Commission on Medicaid and the Uninsured. (2007). Total Medicaid Spending, FY 2005. Retrieved June 14, 2007, from http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?previewid=3&action=compare&category=Medicaid+%26+SCHIP&subcategory=Medicaid+Spending&topic=Total+Medicaid+Spending%2c+FY2005
4 Bush, J. (2005). Florida Medicaid Modernization Proposal. Tallahassee, Florida: Office of the Governor.
5 Duncan, R. P., Lemak, C. H., Vogel, B., Johnson, C., & Porter, C. K. (2004). Evaluating Florida’s Medicaid Provider Service Network Demonstration Project. 5 5 Gainesville, Florida: University of Florida, Department of Health Services Research, Management and Policy.
6 Duncan, R. P., Lemak, C. H., McKay, N. M., Hall, A. G., & Bell, L. L. (2006). Summary Report on Section 1115 Waiver Process. Gainesville, Florida: University of Florida, Department of Health Services Research, Management and Policy.