AHCA, nursing homes disagree on managed care change

BY THE NEWS SERVICE OF FLORIDA

A top official at the Agency for Health Care Administration on Tuesday objected to a nursing-home industry proposal to exclude some seniors from the state's Medicaid managed-care program. The Florida Health Care Association, which represents nursing homes, is urging lawmakers to allow seniors who need intensive long-term care in nursing facilities to receive Medicaid-funded services outside of managed-care plans. But Beth Kidder, interim Medicaid director at the Agency for Health Care Administration, told the House Health & Human Services Committee on Tuesday that the agency disagrees with the nursing-home industry's proposal. Lawmakers in 2011 approved a Medicaid overhaul that included requiring most beneficiaries to enroll in HMOs or other types of managed-care plans. Part of the concept involved using managed-care companies to provide services to seniors in communities, rather than in nursing homes. Deborah Franklin, a Florida Health Care Association official, told the House committee that the industry group supports the concept of serving seniors in their homes and communities. But she said managed-care plans are not appropriate for many seniors who, because of their conditions, will stay in nursing homes for long periods. "For long-term care residents, the state is paying managed-care companies an administrative fee to manage their care, yet these individuals are receiving no additional services or care," she said. But Kidder said agency officials "believe strongly that the entire continuum of care needs to be kept together" under the managed-care system. "We have a difference of opinion with the industry in that (the agency doesn't believe) long-stay residents should be given up on," she said. "We have seen multiple cases and many, many occasions where people (who) have been in nursing facilities for years can go home."