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Medicaid Reform: Legislature Should Delay Expansion Until More Information Is Available to Evaluate Success, Report No. 09-29, June 2009
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  • Medicaid Reform, implemented in August 2006, is intended to empower beneficiaries to take an active role in their health care. Medicaid Reform offers beneficiaries a choice among managed care options; guidance in selecting a health plan that meets their needs; and monetary incentives to increase healthy behaviors. Reform also is intended to encourage managed care plans to enroll sicker beneficiaries by paying plans based on the health status of the persons they serve. Overall, Reform is expected to improve beneficiaries’ access to and quality of health care services.

  • Through December 2008, the state spent $37.8 million to implement and administer Medicaid Reform. Most of these costs (94%) paid vendors to administer and operate the choice counseling, opt-out, and enhanced benefits components; to evaluate the pilot per waiver requirements; and to develop and manage other Medicaid Reform requirements such as health plan contracts, benefit package design, risk-adjusted payment rates, and other technical support. The remaining 6% paid for Agency for Health Care Administration personnel salaries and benefits associated with Reform activities.

  • To date, little data is available to demonstrate that Medicaid Reform has improved access to and quality of care. While AHCA has developed a system to track services provided to beneficiaries, this system will not have complete plan service data available until January 2010. In addition, little data is yet available on whether Medicaid Reform has produced cost savings or is more cost-effective than traditional Medicaid. We recommend that the Legislature not expand Medicaid Reform until more information is available to evaluate success.

Which Government Program Summaries contain related information?

Medicaid Health Care Services

What other OPPAGA-related materials are available?

  • Report No. 08-64 Medicaid Reform: Reform Provider Network Requirements Same as Traditional Medicaid; Improvements Needed to Ensure Beneficiaries Have Access to Specialty Providers,published in November 2008.
  • Report No. 08-55 Medicaid Reform: Oversight to Ensure Beneficiaries Receive Needed Prescription Drugs Can Be Improved; Information Difficult for Beneficiaries to Locate and Compare,published in September 2008.
  • Report No. 08-54 Medicaid Reform: Risk-Adjusted Rates Used to Pay Medicaid Reform Health Plans Could Be Used to Pay All Medicaid Capitated Plans,published in September 2008.
  • Report No. 08-46 Medicaid Reform: Choice Counseling Goal Met, But Some Beneficiaries Experience Difficulties Selecting a Health Plan That Best Meets Their Needs,published in July 2008.
  • Report No. 08-45 Medicaid Reform: Beneficiaries Earn Enhanced Benefits Credits But Spend Only a Small Proportion,published in July 2008.
  • Report No. 08-40 Medicaid Reform: Two-Thirds of the Initial Pilot Counties' Beneficiaries Are Enrolled in Reform Plans,published in June 2008.
  • Report No. 08-38 Medicaid Reform: More Managed Care Options Available; Differences Limited by Federal and State Requirements,published in June 2008.
  • Report No. 08-37 Medicaid Reform: Few Beneficiaries Have Participated in the Opt-Out Program,published in June 2008.

Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
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