Florida Medicaid Children’s Medical Services Program to be Privatized

April 2018 ~

The Florida Department of Health (DOH) has announced plans to privatize management of the Children’s Medical Services Managed Care plan (CMS plan) and has released an invitation to negotiate (ITN DOH 17-026) for a contractor(s) to provide comprehensive managed care services for the CMS plan.

The current CMS plan utilizes a managed care financing model run by the state and provides Medicaid health care services to children ages birth to 20 with serious chronic physical or developmental conditions. If accepted, the ITN would change how the program is managed, but does not substantially change who receives services or the benefits delivered.

Under the new model, the private managed care plan will be responsible for providing physical health, behavioral health, and pharmacy services. As well, care coordinators will be transitioned to the vendor. The new proposed care coordination structure allows for care coordinators to access readily available date and information such as hospital admissions, emergency room visits, drug prescriptions and refills. It also includes four levels of tier case management, with the goal being to reduce the caseload for care coordinators:

  • Tier 1 Case Management includes children residing in a nursing facility (1:15 ratio)
  • Tier 2 Case Management includes children receiving private duty nursing in the community (1:40 ratio)
  • Tier 3 Case management (1:90 ratio)
  • Disease Management is for those opting out of case management (1:200 ratio)

The state plans to contract with either one statewide contractor or one contractor per regional cluster. Proposals are due at the end of April and the contract is scheduled to run from January 1, 2019, through September 30, 2023.

For more details regarding Florida’s move to Managed Care, see the complete Invitation to Negotiate CMS Managed Care Plan.



Source(s): Open Minds; Florida Health;