AHCA: Home Care Providers and Their Role in Medicaid Managed Care

Medicaid ReformThe Agency for Health Care Administration recently presented a webinar on Statewide Medicaid Managed Care (SMMC) for long-term care (LTC) providers, including home health agencies. The webinar detailed the basic components of Medicaid’s transition from fee-for-service to managed care, as passed into law in 2011 and approved by the federal government last month. The state will begin enrolling Medicaid recipients into managed care plans beginning August 1 in District 7 (Orange, Osceola, Seminole and Brevard counties).

The webinar noted that of the 3.3 million Medicaid recipients, over 1.5 million are enrolled in a managed care plan already and that 87,000 are likely eligible to enroll in the new Long-Term Care managed care program. The long-term care program will consist of individuals 65 years of age or older and in need of nursing facility level or care, or those who are 18 years of age or older and have a disability and need nursing facility level of care. Individuals enrolled in certain waivers are required to be enrolled in the LTC program. An important change impacting home care providers is the consolidation of Medicaid waiver programs. Specifically, the following program will end with the implementation of the LTC managed care program:

  • Aged and Disabled Adult Waiver
  • Channeling Services for Frail Elders Waiver
  • Nursing Home Diversion Waiver

Providers that are interested in being part of SMMC must be enrolled in a LTC managed care plan provider network. Between October 1, 2013 and September 30, 2013, each of the selected managed care plans must offer a network contract to all home care agencies in their region that previously participated in home and community-based waivers serving elders or community-service programs administered by the Department of Elderly Affairs. So far, seven health plans have already been selected to provide services to Medicaid recipients under Statewide Medicaid Managed Care. Home care providers that are interested in providing care to Medicaid recipients are strongly encouraged to make contact with these organizations in order to be on the front lines when managed care is implemented.

The presentation makes one thing abundantly clear: there is an increased emphasis on home and community based services, and this could prove to be a boon for home care providers. To review the presentation in full, including contact information for the seven selected health plans, click here to visit the HCAF Resources for Medicaid Providers webpage.

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