Last month, all older adults enrolled in the long term Medicaid program received letters stating there is an open enrollment period from June 1-August 1,2 013 for a new managed care long term care diversion program. As of August 1, 2013, any older adult receiving services under the long term care Medicaid program and the diversion program serving those living independently in the community and/or in an Independent or Assisted Living community will be combined into one new program. The state of Florida has contracted with four Managed Care Organizations (MCO’s) to be responsible for their care which is not covered by Medicare. Included in this are the Medicare co-pays now paid by Medicaid. Orlando is the test site for this program. How it will operate remains to be seen. There are at least 33,000 people on the waiting list for the Home Based Community Services Program (HBCS) since the funds are frozen until after August 1, 2013.
What does this mean for your loved one? During the open enrollment period, representatives from Automated Health Systems, hired by the state, will meet with Social Workers/Discharge Planners at all long term care units to present the program. Your loved one will have to enroll in one of the four programs contracted by the state. They are Coventry (now owned by Aetna), Sunshine State (new to area), United Health Care, and American Eldercare. Each of these companies have their own provider networks. When your loved one enrolls in a program, they must determine that long term care facility is contracted with that specific MCO.
The MCO’s will receive compensation like any other HMO. It will be per member per month. The reimbursement they receive from the state may be less than the cost of the long term care. Therefore, they will be incentivized to transfer your loved one to a lower level of care which they are contracted with. As a family member/friend/advocate, you must become involved with your loved one in this process of open enrollment and develop a relationship with their Care Manager. This will be crucial in making sure your loved one receives appropriate care for his/her needs.
For additional information, contact me at the Orlando Senior Help Desk, 407-678-9383.
Orlando's Senior Help Desk is a free service of the Jewish Pavilion. We are financially supported by our generous sponsors and participating communities. Information provided is not to be considered medical or financial advice and users should consult with a licensed professional before making any final decisions. Orlando's Senior Help Desk and the Jewish Pavilion complies with the Can-Spam Act of 2003.
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