The state Agency for Health Care Administration (AHCA) has adopted crucial protections for residents who seek to disenroll from their health care plans for “good cause.” The Florida Policy Institute pushed for these protections in comments submitted to AHCA back in October.
This month, Florida started a statewide roll-out of new Medicaid managed care plans. Over 3 million beneficiaries are affected. Nearly 600,000 will be required to change plans because AHCA is no longer contracting with their current plan.
Once a beneficiary selects a new plan and the time for making a change expires, they are “locked in” for 12 months. However, by law, beneficiaries can disenroll sooner for “good cause.” This is a particularly important consumer protection for people who have a serious illness or disability. They are the ones with the most to lose if they are locked into a plan that cannot meet their needs.
AHCA implements the good cause protections through an administrative rule. In an earlier blog we outlined our concerns with AHCA’s proposed changes to the rule —notably, that they were being pushed out shortly before the statewide roll out of the new plans. This is a time of transition, when beneficiaries are particularly at risk of disruptions in care. During the public notice and comment period, FPI shared these concerns with AHCA and made specific recommendations for improvements.
On November 26, 2018, AHCA published a Notice of Change made in their proposed rule, which includes some of FPI’s key recommendations:
These changes are a win for Florida Medicaid consumers. We applaud AHCA for making these improvements.