•  
  •  
 

St. Thomas Law Review

Rebecca C. Bell

First Page

103

Document Type

Article

Abstract

Medicaid is a nationwide health insurance program, created in 1965 as Title XIX of the Social Security Act for the poorest and sickest individuals. The Medicaid program operates through a federal and state partnership with the Centers for Medicare and Medicaid Services ("CMS") providing federal oversight. States must provide coverage of certain groups and services in order to receive federal funds for their Medicaid programs. However, states may include additional "optional" groups and services in each state plan. States use different methods of service delivery to Medicaid beneficiaries. In July 2011, a national average of 74.22% of Medicaid beneficiaries were enrolled in managed care organizations. Although Medicaid managed care organizations grew rapidly in the mid-1990s, few states implemented a managed care program for Medicaid long-term care and instead used various models of delivering services within the fee-for service system. State and Federal governments have been looking at Medicaid managed long-term care again because of increased budget pressures. Part II of this article will describe how Medicaid managed care functions. Florida's historical use of Medicaid managed care and the current, unprecedented implementation of a new statewide, mandatory Medicaid managed care program is examined in Parts III and IV. Part V will explain developments on the federal level in the area of Medicaid managed care and specifically with the dual-eligible population, including the recently issued CMS Guidelines for providing long-term services and supports ("LTSS") through Medicaid waivers. Part VI will evaluate Florida's implementation of Medicaid Managed Long-Term Care ("MMLTC") in comparison to the CMS Guidelines. Part VII will look at Arizona as a model for Medicaid managed long-term Care.io The article concludes that although Medicaid managed care has potential to improve coordination of health care services and decrease Medicaid spending, Florida's Medicaid Long Term Care Program must be implemented with substantial, continual monitoring and oversight with emphasis on increased improvement in quality assurance measures and procedures.

Download

Included in

Elder Law Commons

Share

COinS