Florida managed care plans that participate in Medicaid and the state’s KidCare program fall below the national median in follow-up hospitalizations for mental illnesses for children, according to study findings released last week by the Trump administration.
The study of Medicaid managed plans and KidCare, a subsidized Children’s Health Insurance Program (CHIP) for 2.4 million Florida children who don’t qualify for Medicaid, garnered the state a mixed “scorecard” of determinations.
Based on 2018 data collected by the federal Centers for Medicare & Medicaid Services (CMS), the report examines the performance of 17 managed care plans that cover patients in Medicaid, the safety-net program for nearly 4.2 million low income Floridians.
Florida’s managed health plans fare well in areas such as breast-cancer screenings for women between the ages of 50 and 74, and annual well-care visits for teenagers, but trail other states in mental-illness treatment and emergency room visits, according to the report.
Nationally, the report cites the median percentage of women in the 50-74 age bracket who received mammograms was 54.6 percent. In Florida, the median rate was 58.2 percent. Florida managed care plans also outperformed the median rate of people ages 12 to 21 who received annual well-care visits, according to the report.
Nationally, the median rate of children who received well-care visits was 48.9 percent, the report cites. In Florida it was 57 percent.
The report states that the standard for treating adults and children with mental illnesses is to have visits with mental-health providers within 30 days of discharge. For adults with mental illnesses, the national median was 38 percent for follow-up visits within the recommended time frame.
Florida Medicaid and KidCare fell below the national medians in these scorecard categories.
In Florida, according to the report, only 30.5 percent were seen within 30 days of discharge.
Florida Medicaid and KidCare managed-care plans also did not compare well with those in other states in the percentage of live births off babies who weigh less than 5.5 pounds. The national median was 9.1 percent, but in Florida, it’s slightly higher than 10 percent.
Florida’s Agency for Health Care Administration (AHCA), which manages Florida’s $30 billion Medicaid base budget for nearly 4.2 million state residents, has submitted a Fiscal Year 2021 budget request that includes a 2.7 percent increase amounting to an additional $191.9 million in program spending next year.
In 2005, the CMS approved Florida’s 1115 Managed Medical Assistance waiver based on the state’s “Medicaid Reform” pilot program in Broward, Duval, Baker, Clay and Nassau counties that established a Low Income Pool (LIP) to deliver health care services to underinsured and uninsured populations.
Florida is one of 19 states that have not expanded Medicaid under the Affordable Care Act. Instead, In 2011, the Florida Legislature directed the AHCA to create the Statewide Medicaid Managed Care (SMMC) program with two components, Managed Medical Assistance (MMA) and the Long-term Care (LTC).
In 2013, the state terminated its “Medicaid Reform” program and implemented its MMA program. The following year, the CMS agreed to extend all portions of the MMA Waiver for three years, with the exception of the LIP program, which remained annually reviewed.
In 2017, Florida received approval from CMS to extend all portions of the MMA Waiver, including the LIP program, from August 3, 2017 through June 30, 2022. The approval from CMS allows the state to continue operating the MMA program while increasing the LIP to $1.5 billion annually.
During the 2019 legislative session, lawmakers approved a pilot program that provides additional behavioral health services and supportive housing assistance services for persons aged 21 and older with serious mental illness, substance use disorder, who are homeless or at risk of homelessness due to their disability.
Among proposed 2020 initiative is the state’s Department of Children & Families’ (DCF) $15.7 million funding request, including $9 million for Community Action Treatment (CAT) Team expansion, for substance abuse and mental health programs.