FL Healthcare1
Issue Background

Exempt Long-Stay Nursing Center Residents from Florida's Medicaid Managed Care System

FHCA is asking the Legislature to support SB 682 by Sen. Kelli Stargel/HB 1059 by Rep. Alex Miller, which ensure timely payments from and provider access to managed care networks.

SB 682 also exempt long-stay residents from managed care once it is determined that the nursing center is the safest place for them to receive their care.

Taxpayers could save $68.2 million in administrative costs and case management fees.

Lack of uniformity in policies and standards among managed care organizations creates administrative burden for both nursing centers and residents:

  • Delays in Payments
  • Coordination of Care Redundancy
  • Shrinking Provider Networks
  • Barriers to Transportation & Services


Click Here to Email Your Senator and Urge Them to Vote YES on SB 682!

In 2013, Florida implemented the Statewide Medicaid Managed Care Long Term Care Program (SMMC-LTC) to contain health care costs and provide consumers with expanded services. While managed care may be meeting those goals in some areas, there is no data to suggest that managed care is reducing costs and improving outcomes for Florida’s long-stay, nursing center residents.

As of July 2014, there were 45,681 SMMC-LTC enrollees receiving services in a nursing center. By July of 2016, that number had risen to 46,899.  In the SMMC-LTC program, savings are achieved when residents are either delayed from entering or transitioned out of the nursing center to a lower cost of care setting.

The state of Florida could save approximately $68.2 million ($36.5 million in administrative costs / $31.7 million in case management fees) by exempting long-stay nursing center residents when it is determined that transitioning them to a lower cost setting could not safely be performed.

A January 2017 report by Moore Stephens Lovelace CPAs notes that the number of enrollees in the program who receive care at nursing centers grew by 2.6 percent in the two years ending in July. By utilizing traditional Medicaid, case management costs would be cut by about 72 percent while administrative costs would be reduced by approximately 54 percent. Read the report here.

Delays in payments to nursing centers negatively impacts the center’s ability to provide quality care to Florida’s most vulnerable citizens. On average, nursing centers are carrying over $200,000 in outstanding Medicaid managed care claims per center. While awaiting payment, centers continue to provide care for Medicaid residents, incurring all the costs necessary to do so.

Nursing centers are operating on thin margins, with a shortfall in Medicaid reimbursement of nearly $14 per patient per day. Payment delays by managed care organizations for care that has already been provided to residents significantly impedes cash flow, jeopardizing operations and making it challenging to pay for the costs associated with providing resident care.

Managed care plans are also beginning to shrink provider networks. Residents must often choose between moving to a new nursing center that accepts their current plan, or change to a different plan that contracts with their current nursing center.

Click Here to Download Our Issue Brief.

Watch Below: FHCA Presentations Before Senate Appropriations Subcommittee on Health & Human Services (2/8/17)

Watch Below: FHCA Testimony on Managed Care Before the Senate HHS Appropriations Subcommittee (12/16)