Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

CMS Approves State Capitated Medicaid Program in Florida

At part of a CMS section 1115 demonstration, Florida will now operate a low-income, state capitated Medicaid program over five years.

Florida recives CMS approval for more funding via a section 1115 waiver.

Source: Thinkstock

By Thomas Beaton

- Florida received CMS approval to operate a state capitated Medicaid program and a low-income pool (LIP) to improve care for uninsured individuals, the federal agency announced.

The state submitted a request to extend Florida’s Managed Medicaid Assistance (MMA) program through a CMS section 1115 demonstration waiver. The request met the federal agency’s guidelines to plan effective healthcare procedures that improve health outcomes for vulnerable Floridians.

“This program gives Florida the ability to care for its most vulnerable and at-risk citizens. Its renewal also provides flexibility to use the funds in a way that meets the unique needs of the State while reducing burden by eliminating duplicative reporting and documentation requirements,” said CMS Administrator Seema Verma.

“This extension has a positive and direct impact on people’s lives and their ability to access care. Florida’s program offers an innovative and realistic pathway to tackling some of Medicaid’s biggest challenges.”

The extension gives the state’s MMA program two new resources to meet healthcare goals related to the care of low-income, uninsured individuals.

The first involves necessary financial support to public teaching hospitals, children’s hospitals, and other hospitals for the care they furnish to low-income uninsured Floridians. CMS will also provide resources that improve care access and increase quality provider participation in Florida’s MMA program, including care provided by many Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC).

The agreement marks a first for the state in having received CMS approval for the flexibility demonstration of a new approach to state reporting activities. The federal agency will monitor progress toward state-selected benchmarks and work with the state to design a meaningful evaluation. These changes aim to lessen inappropriate or burdensome state reporting activities.

Florida’s request for a waiver follows efforts in other states across the country that require additional Medicaid resources and flexibilities due to public healthcare needs. The most recent examples required funding extensions to stall low-income care programs and develop preventative care services.

Texas submitted a 1115 waiver earlier in the year to avoid shutdowns in public programs that require funding to ensure they can deliver healthcare to low-income individuals.

“We believe this extension is necessary to allow the new administration and the 115th Congress to make changes to the nation's health care system, and the Medicaid program specifically, during 2017,” said Texas Health and Human Services in their waiver request letter. “This extension would provide financial and operational certainty for Texas providers to continue serving Medicaid and low-income uninsured populations that benefit from the waiver.”

Another pending waiver submitted earlier in the year by Wisconsin would add drug testing, positive health behavior incentives, and premium payments to specific beneficiaries during the 2018 enrollment period.

Eleven other states submitted waivers to pursue increased drug treatment via federal funding, where the waivers would waive current policy on the number of beds government funds can cover within addiction treatment facilities.

The Florida 1115 approval is the latest that reiterates CMS commitments to improving Medicaid care, which were addressed in a March 14th letter to state governors from the heads of HHS and CMS.

“We intend for this to be the beginning of a discussion on how we can revamp the federal and state Medicaid partnership to effectively and efficiently improve health outcomes,” said Verma in the letter.

“We look forward to partnering with you in the years ahead to deliver on our shared goals of providing high quality, sustainable, health care to those that need it most.”

X

Sign up for our free newsletter:

Our privacy policy

no, thanks