Florida Medicaid provides healthcare to many individuals facing economic and social barriers to help improve their health and wellbeing. Medicaid covers 4.5 million Floridians, of which 3.5 million are enrolled in Medicaid managed care.1
Program history
Serving Florida since 2006
MCOs have worked with the state of Florida for over a decade, helping to deliver a higher standard of healthcare to millions of Floridians.
2006
Medicaid managed care pilot launches in Florida
2011
Medicaid managed care expands to all Florida counties
2012
Two-thirds of Florida’s Medicaid beneficiaries enrolled in managed care2
Program population
In Florida, MCOs are responsible for program administration, including network management, claims payment, care coordination, and utilization management.
Since their launch in the state, MCOs have helped to:
- Double the amount of primary care providers in each network
- Expand access to after-hours care
- Improve transportation to ensure members get to appointments on time10
In 2019, 1 in 9 adults, 3 in 7 children, and 1 in 3 individuals with disabilities were covered by Florida Medicaid4
4 in 7
nursing home residents are covered by Florida Medicaid4
Standards of care
How MCOs are held accountable
Unlike the fee-for-service approach, the managed care model is measured against specific quality standards by federal and state governments. MCOs are accredited and regularly reviewed using up to 69 quality measures by the National Committee on Quality Assurance (NCQA) as well as by state agencies.5
Performance measures set by states ensure that MCOs deliver consistent, high-quality care that is aligned with state strategies to improve population health, while also providing competition and choice for recipients.
In 2019, 67% of Florida’s managed Medicaid programs’ Healthcare Effectiveness Data and Information Set (HEDIS) quality scores met or exceeded the national average.3 In 2019, 77% of adults in Medicaid rated their health plan 8/10 or higher.6
Managing costs and risks
Delivering transparency and predictability
With the costs of healthcare rising, MCOs help Florida better plan and manage its budget, while ensuring that a growing number of Medicaid recipients get the quality healthcare they deserve.
Florida MCOs provided estimated Medicaid savings of $420 million in 2016 and $441 million in 2017.7
MCOs use a range of strategies to run cost-effective programs, including helping patients receive preventive services, providing supportive care for members with complex conditions, and managing the provider network.
Florida’s MCOs and the Agency for Health Care Administration are committed to reducing potentially preventable hospital admissions by 22%, reducing hospital readmission by 21%, and reducing preventable emergency room visits by 14%.10
Higher quality care
Improving population health
11%
increase in prenatal care in the first trimester between 2013 and 20178
The managed care model is based on the delivery of quality care that provides services that are medically necessary for people when they need them. MCOs empower members to engage with their own healthcare, providing education around and support for preventive services.
In 2017, 69% of infants had regular well-child visits with their primary care doctors, and 90% of older adults had annual visits with their primary care doctors through Florida Medicaid.8
Between 2013 and 2017, there was also a 9% increase in annual dental visits.10
Overall, MCOs in Florida provide more than 55 additional benefits to people in Medicaid, including substance abuse and mental health treatment, alternative pain management services, doula services, and vaccines for adults.10
Patient experience
Coordinated care for Floridians
MCOs coordinate care and provide a single point of contact for Floridians. By coordinating care, MCOs can help treat the whole person, serving as the glue that binds community resources with a unified health strategy, integrating physical and mental health services.
The managed care model, unlike the fee-for-service approach, is built to bring together disparate parts of the delivery system. MCOs are incentivized to partner with community groups to address social determinants of health, which can have a significant impact on the health of Floridians.
On a national level, MCO’s social determinants initiatives are widespread and address numerous aspects of health, with 77% of MCOs reporting housing activities, 73% reporting nutrition activities, and 51% reporting education activities that aid the Medicaid population.9
73%
of MCOs nationally report nutrition activities.9
Provider experience
Helping states help providers
Through Medicaid managed care, providers benefit as well. MCOs use value-based payment models that incentivize, empower, and reward providers for their quality of care.
MCOs also help maintain strong provider networks and offer clinical support, continuing education, and technological innovations that enable providers to deliver higher quality care.
Managed care in Florida also helps to reduce administrative burdens by allowing high-performing providers to bypass prior authorization and completing credentialing for network contacts in 60 days.10
Sources
- “Florida Statewide Medicaid Monthly Enrollment Report,” Agency for Health Care Administration, 2022.
- “Managed Care in Florida,” Medicaid.gov, 2014.
- “Florida’s Medicaid Program Reaches Highest Quality Ratings Ever,” Agency for Health Care Administration, 2020.
- “Medicaid in Florida,” KFF, 2019.
- “NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report (Private/Commercial),” NCQA, 2020.
- “Health Plan Information,” floridahealthfinder.gov, 2020.
- “Potential Savings of Medicaid Capitated Care: National and State-by-State Estimates,” ACAP, 2017.
- “Quality Improvement Goals for Health and Dental Plans,” Agency for Health Care Administration, 2018.
- “The Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans,” KFF, 2018.
- “Statewide Medicaid Managed Care: Overview,” Agency for Healthcare Administration, 2018.