The Florida Health Care Association today rejected figures developed by the state that suggest a proposal to remove skilled nursing centers from managed care would carry an extreme cost. The state’s calculations are seriously flawed, FHCA told a Senate committee, and instead of the $200 million cost identified by the state, the carve-out would actually save taxpayers $68.2 million per year.
The state Agency for Health Care Administration has shared its estimate of the impact of excluding nursing centers from the managed long term care component of the Statewide Medicaid Managed Care system. However, FHCA told members of the Senate Health and Human Services Appropriations Subcommittee that the state agency’s numbers were based on incorrect assumptions.
Tom Parker, FHCA’s Director of Reimbursement, testified that the state figures are based on an assumption of what it would cost the state IF individuals who received home- and community-based services during certain times had instead been cared for in a nursing center. “But that’s not how the system works, and it’s not what this bill does,” Parker said. “Rather, this bill focuses solely on exempting long-stay nursing center residents. There are no savings to be realized for these individuals, because their health and medical needs can only be addressed in a nursing center. They cannot be safely cared for in a home or a community setting.”
Florida’s system of managed care does not work effectively for long-stay nursing center residents who can’t take care of themselves or be safely cared for in the community. Parker cited data previously announced by FHCA showing that the system is costing taxpayers approximately $68.2 million in unnecessary fees each year by charging for management services that are not needed.
More than 47,000 Floridians live in nursing centers and are enrolled in the long term managed care program, a 25 percent increase since 2014. Parker said managed care ensures that only those who truly need nursing home care are admitted into nursing centers – but that amounts to less than 2 percent of Florida seniors over the age of 65, well below the national average is 5 percent.
“Florida is doing a much better job than other states and the nation at ensuring seniors are receiving care in the most appropriate place and the least restrictive setting,” Parker told senators.
Managed care does not work well, however, for long term stay residents, those who are in nursing homes for more than 60 days. Parker pointed to state data showing that managed care companies transition only about 4 percent of the nursing home Medicaid population into community care, leaving the remaining 96 percent continuing to receive their care in skilled nursing centers.
“For those individuals, we believe that the state and the nursing home can save money if they returned to a straight fee for service,” Parker said. “Florida has a long-standing commitment to help elders stay in their homes or community settings for as long as possible. But we must also recognize that for more and more of the frailest residents, a nursing home is the best – and perhaps only – realistic option.”
Additional FHCA witness reinforced the benefits to both residents and the nursing centers from excluding them from the managed care system
For more information about Florida Health Care Association and their legislative initiative to exempt long-stay nursing residents from Florida’s Medicaid Managed Care System, visit http://tinyurl.com/FHCAMgdCare17.
