Medicaid Undergoes Changes –AHCA Striving For Smooth Transition–

By Rose Klein Greene Publishing, Inc. Changes to Medicaid was the topic of last week’s meeting at the Senior Citizen Center, where secretary for the Florida Agency for Health Care Administration (AHCA), Elizabeth Dudek, spoke to Medicaid recipients and recipient advocates on the potentially confusing changes the public healthcare program was undergoing. The AHCA is a government agency that has two primary responsibilities in the state of Florida. One of their responsibilities is the licensure of the state’s 45,000 health care facilities; this includes hospitals, nursing homes, assisted living facilities and doctor’s offices. Their responsibility lies only with the buildings and equipment, not with the licensing of practitioners. The agency checks the healthcare facilities to ensure they are complying with state and federal requirements and also investigates complaints. The other responsibility the AHCA covers is the estimated $22.9 billion Medicaid program that will serve a projected 3.48 million in Florida this coming year. The agency strictly covers the funding of Medicaid, not eligibility and they are not responsible for Medicare. Dudek said that 4,000 people in Madison will be affected by the change and even though the changes are designed to make coordinating care easier, she acknowledged the transition will be difficult for some. Traditionally, those who receive Medicaid went to the health provider of their choice and Medicaid sent payment directly to that provider. Hoping to consolidate the program, Medicaid has divided healthcare into two main plans. The Long-term Care (LTC) plan covers recipients needing skilled care, such as primarily disabled and elders (which make up about 90 percent of Medicaid’s recipients). Care can be received in the home or at a nursing facility. LTC benefits include: adult companion care, adult day health care, assisted living, assistive care services, attendant care, behavioral management, care coordination/case management, caregiver training, home accessibility adaption, home-delivered meals, homemaker and hospice. This program actually “went live” on Nov. 1, 2013. The big change is that recipients will now have to choose a long-term care provider: American ElderCare or United Healthcare. Dudek said that if a Medicaid recipient didn’t choose by the date scheduled, Medicaid would choose for them by looking at their services most used and then picking the provider that best fits those services. Medicaid’s second new plan, the Managed Medical Assistance (MMA) covers primarily children and pregnant women. MMA’s standard benefits include: advanced RN services, ambulatory surgical treatment center services, birthing center services, chiropractic services, dental services, early periodic screening diagnosis and treatment services for recipients under age 21, ER services, family planning services and supplies, healthy start services, hearing services, home health agency services, hospice services, hospital inpatient services, hospital outpatient services and laboratory and imaging services. The two providers available for selection in this plan are Prestige and WellCare. This program will “go live” on May 1 of this year. An advantage for both plans is every recipient will be given a case manager who will be available to answer any questions a recipient may have with their new plan and will ensure all healthcare needs of the recipient are being met, including covering transportation to any covered appointment if the recipient can’t find transportation on their own. Preventative care will be stressed, such as chiropractic care and smoking cessation and the new plans will cover some care not previously covered, such as dental plans, allowance for a second pair of glasses and the shingles vaccine. Medicaid recipients will be issued a letter, welcoming them to the new plans or may have already received a letter. If assistance is needed with the letter, or with help selecting a plan, there is another new service that can help. Choice Counseling has counselors ready to assist those needing help with the transition. You can call Choice Counseling at 1-877-711-3662, 1-866-467-4970 (TDD), or email them at www.FLmedicaidmanagedcare.com. For a general Medicaid question, call 1-800-248-2243.

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