HMO Expansion and Medical Home Pilot are Potential Features of Florida Medicaid Program Overhaul

Wednesday, March 31, 2010 Health Insurance News
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NASHVILLE, Tenn., March 30 HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that Florida legislators are considering expanding managed care and adopting a patient-centered medical home pilot as part of an effort to reform the state's Medicaid program and eliminate a $2 billion program budget deficit. According to the recent Florida Health Plan Analysis, the overhaul is necessary as increased demand for state-sponsored healthcare services has grown significantly because of recession and changing demographics in the state.

According to the report, enrollment in the Florida Medicaid program is approaching three million beneficiaries. Medicaid in Florida currently relies heavily on a fee-for-service format. While a shift toward greater Medicaid HMO enrollment would yield cost savings, it will be a challenge for the state as Medicaid HMOs have had trouble establishing provider networks in rural areas of the state because of lower reimbursements.

A second concept considered for Florida's Medicaid program is the creation of a patient-centered medical home pilot program. The medical home concept is a collaborative care model in which a primary-care physician tracks a patient throughout the continuum of care, including specialist visits and medication compliance. Advocates believe the increased maintenance associated with the medical home concept leads to improved patient compliance and lower healthcare costs.

"Florida's Medicaid program currently faces a $2 billion budget deficit, and despite an upturn in the economy, elevated enrollment will likely continue," said Roy Moore, senior analyst with HealthLeaders-InterStudy. "The state will likely establish a medical home pilot in Tampa and in a rural part of the state, and assess how this program compares with managed Medicaid and the current fee-for-service model in controlling costs."

Other topics highlighted in the recent Florida Health Plan Analysis include:

Why Pharmaceutical Company Managed Markets Teams Need Health Plan Analysis

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About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit

About Decision Resources, Inc.

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-- Increased interest in consumer-directed health plans across the state as commercial health plan enrollment declines. -- The growth of health savings accounts among self-funded groups; state rules have stifled similar growth among fully insured plans. -- Cover Florida -- with low enrollment and high costs, the campaign has failed to make a significant dent in the number of uninsured in the state.

SOURCE HealthLeaders-InterStudy

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