KFF explains, analyzes Florida Medicaid waiver

On October 19, 2005, CMS approved a Section 1115 waiver, allowing Florida to make fundamental changes in its Medicaid program. The state is seeking to improve predictability of Medicaid spending and reduce the rate of spending growth through the waiver. It is also looking to increase personal responsibility, market competition, and participation in private coverage.

Florida’s approach could have significant national implications if it becomes a model for other states. Under the waiver, the program will move toward a defined contribution program in which the state will allot risk adjusted premiums to beneficiaries to choose among different coverage options. Managed care plans will gain new authority to determine benefits for adults, subject to state approval, and the state will establish a new annual maximum benefit limit for adults. Beneficiaries will also be able to “opt-out” of Medicaid and use their risk-adjusted premium to subsidize the purchase of employer-sponsored or individual coverage if it is available.

Interested in knowing more?  Read the Fact Sheet, entitled Florida Medicaid Waiver: Key Program Changes and Issues