MM Curator summary
[ MM Curator Summary]: A recent audit suggests the two programs do not duplicate services, but the Medicaid agency disagrees.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
A look at the millions of dollars Florida is spending on health care and social services for pregnant women, infants and children shows little duplication and offers good news to those who support the programs.
A recently released report conducted by the Office of Program Policy and Government Accountability shows there’s not much overlap in care provided by state-contracted Medicaid managed care plans versus services offered by the Florida Healthy Start program.
“Overall, the report is extremely positive,” Catherine Timuta, chief executive officer of the Healthy Start MomCare Network, told Florida Politics Tuesday. “There weren’t any significant findings of duplication.”
OPPAGA began a review of the services the HealthyStart MomCare Network and statewide Medicaid managed care plans offer pregnant women to see if they were duplicating services and whether those services meet state and federal requirements.
To that end, OPPAGA researchers reviewed contracts between Medicaid-managed care plans and the Florida Association of Healthy Start Coalitions, which contracts with the plans on behalf of 33 local groups.
OPPAGA also reviewed Agency for Health Care Administration contracts, including one between AHCA and the Healthy Start MomCare Network, which holds contracts with the state on behalf of the 33 local Healthy Start Coalitions.
“These agreements show overlap between the entities in two areas: care coordination and data sharing,” the OPPAGA report notes.
Timuta noted, however, data sharing is mutually beneficial for the health plans and the coalitions, because it provides both entities with information on the enrollees and the services they receive.
To delve into the coordination of services, OPPAGA staff conducting the research also did follow up interviews with Healthy Start and representatives from Medicaid health plans to get additional details on the care coordination services provided. Eight of the nine health plans told OPPAGA there was no service duplication.
“While some services provided by health plans and Healthy Start may appear similar, Healthy Start and health plan staff reported that services provided via the two entities are largely distinct and complementary,” the report notes.
The Health plans and Healthy Start both provide home visits, but Healthy Start staff told OPPAGA researchers their program participants are visited at least once a month and are provided prenatal education, parenting education, interconception education, stress management education and screenings. The health plans told OPPAGA researchers home visits for health plans are short-term services and have a more medical focus.
AHCA, though, didn’t see things the same way.
According to the report, “AHCA staff reported that some services included in the AHCA-MomCare Network contract are also covered under the AHCA-health plan.”
However, the report notes that due to data limitations, the existence of duplication cannot be validated.
“OPPAGA staff requested AHCA claims data in an attempt to verify whether service duplication is occurring. However, while Healthy Start services are contained in AHCA’s claims data, health plans reported that the services that may be considered comparable to Healthy Start (e.g., home visits and community referrals) are provided as part of care coordination, which is not a billed service and thus does not appear in the claims data,” the report notes. “Because data for services provided by health plans are not available in AHCA’s encounter data, claims data analysis cannot be used to validate whether there is service duplication between Healthy Start and the health plans.”
According to the report, OPPAGA requested agency staff to provide them with the procedure codes used by health plans to ascertain if there was a difference between social and medical service provisions, but the agency did not provide OPPAGA the information.
OPPAGA is the research arm of the Florida Legislature. It provides lawmakers with data, evaluative research, and objective analyses meant to inform policy decisions.
The report shows that in state fiscal year 2020-21, Medicaid health plans submitted data on 104,935 enrollees to the Florida Healthy Start, of which 66,191 matched a case in the Florida Healthy Start system.
Of those 66,191 women, about 73% of them, or 48,267, received at least one service. When asked about the women who didn’t receive services, Timuta, chief executive officer of the Healthy Start MomCare Network, said the program is voluntary.
The report comes as Florida lawmakers prepare to meet for the 2022 Legislative Session where work on the upcoming fiscal year 2022-2023 budget begins.
The 2021 Legislature appropriated $63.1 million to AHCA for Healthy Start services provided under the contract between AHCA and MomCare, a $21.9 million increase from the prior fiscal year. The funds covered a near $11 million deficit, which AHCA said was caused by COVID-19, and provided services to a growing number of women, infants, and children.
A review of Gov. Ron DeSantis’ proposed budget for fiscal year 2022-2023, though, shows the Governor is not recommending that the $21.9 million bump in funding be continued in the 2022-2023 budget, which lawmakers will work to create when they meet in Session in January.
Christine Jordan Sexton is a Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.