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Florida Medicaid shifting to managed care program

 Medicaid Advisory

Posted 5-22-2013

This is an alert from The Karp Law Firm to its clients and the general public. 

Florida is rolling out a new program that changes the manner in which long-term care Medicaid benefits are handled. Under the new guidelines, all Medicaid long-term care compensation will be administered by state-approved managed care agencies. Previously there were no managed care providers for nursing homes, and numerous providers for assisted living or home care Medicaid recipients. Now, Medicaid recipients living in nursing homes, assisted living, or at home (through either the diversion or waiver program) will be required to choose a managed care provider from among those approved by the state.

This law firm is not involved with the change in any way, nor will it affect our assistance to clients seeking our help to qualify for benefits. This is an advisory only. Our attorneys cannot help individuals or families in the selection process for managed care providers since there is no data that allows us to evaluate their effectiveness.

The program is not yet operational, and the state and managed care providers are still working out details. According to the information we have received, The Florida Agency for Healthcare Administration will begin sending letters in June 2013 to Medicaid recipients (or their representatives) that provide more complete information and explain the steps recipients are required to take.

Right now, we know that people receiving Medicaid services in Palm Beach, Martin, St. Lucie or Okeechobee counties will be required to choose one of the following managed care providers: American Eldercare, Coventry, Sunshine State, or United Healthcare. Medicaid recipients must make their selection by August 22, 2013. If  no choice is made, the state will select a provider for the recipient. If the recipient has a provider currently that is not on the approved list, the recipient will have to choose a new provider from among those on the list.

People receiving Medicaid services in Broward County must choose one of the following managed care providers:  American Eldercare, Amerigroup, Humana, Sunshine State, United Healthcare. As yet we do not have any information about the deadline for selecting a provider.

For more clarity as this process moves forward, please talk to the administration department of your nursing home, or to the managed care provider you are currently working with for home care or assisted living care.

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