Florida Medicaid Reform Pilot
Florida's Medicaid Reform was a comprehensive demonstration that seeked to improve the value of the Medicaid delivery system. The program operated under an 1115 Research and Demonstration Waiver initially approved by the Centers for Medicare and Medicaid Services (Federal CMS) on October 19, 2005. State authority to operate the program is located in Section (s.) 409.91211, Florida Statutes (F.S.), which provides authorization for a statewide pilot program with implementation that began in Broward and Duval Counties on July 1, 2006. The program expanded to Baker, Clay and Nassau Counties on July 1, 2007. Key components of the demonstration include:
- Comprehensive choice counseling,
- Customized benefit packages,
- Enhanced benefits for participating in healthy behaviors,
- Risk-adjusted premiums based on enrollee health status, and
- Low Income Pool.
The Medicaid Reform program was phased out as the MMA program was implemented in each region of the state no later than October 1, 2014, and as approved by Federal CMS. The state authority to operate the Medicaid Reform program sunset October 1, 2014.
Waiver History
The following is an historical description of the waiver since authorization in 2005.
Initial 5-Year Period (2006-2011): On October 19, 2005, Florida's 1115 Research and Demonstration Waiver named "Medicaid Reform" was approved by Federal CMS to operate the demonstration for the period from July 1, 2006 to June 30, 2010. The program was implemented in Broward and Duval Counties July 1, 2006 and expanded to Baker, Clay and Nassau Counties July 1, 2007.
Three-Year Extension Period (2011-2014): On June 30, 2010, a three-year waiver extension request was submitted to Federal CMS to maintain and continue operations of Medicaid Reform for the period July 1, 2011 to June 30, 2014. Federal CMS granted temporary extensions of the program until December 15, 2011, when final approval of the waiver extension request was granted for the period December 16, 2011 to June 30, 2014.
MMA Waiver Amendment (June 14, 2013): On June 14, 2013, Federal CMS approved the MMA amendment that allows for the implementation of a new statewide managed care delivery system without increasing costs and to continue the Low Income Pool program. The previously named waiver "Medicaid Reform" was renamed to "Managed Medical Assistance." Please refer to the Federal Authorities webpage for the amendment approval documents.
MMA Waiver Extension Request (2014-2017): On November 27, 2013, the Agency submitted another three-year waiver extension request to Federal CMS to extend Florida's 1115 MMA Waiver for the period July 1, 2014 to June 30, 2017. Please refer to the Federal Authorities webpage for more information on the waiver extension request.
