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Report: Many Enrollees Don't Understand Florida's Revamped Medicaid Program

By Ben Weyl, CQ Staff

October 14, 2008 -- A substantial number of Medicaid enrollees in Florida's new consumer choice program have struggled to navigate it, leaving some of Florida's most vulnerable citizens, as well as the new program, in an increasingly precarious state, according to a new report published Tuesday in Health Affairs.

Florida embarked on a transformation of its Medicaid system after obtaining a waiver from the Centers for Medicare and Medicaid Services in late 2005. The new program requires enrollees to choose between competing benefits plans rather than receive the previously defined benefits. Proponents of the program had hoped it would improve the efficiency of the Medicaid delivery system and create a competitive market that would encourage recipient involvement.

Those hopes have not yet been realized, however, said the report, based on a 2006–2007 Kaiser Family Foundation survey of enrollees in Broward and Duval counties. The lack of awareness and understanding of the new program is a "pervasive" problem, which seriously endangers the program's efficacy, it said.

Although Florida sent letters to Medicaid enrollees urging them to sign up for a plan, roughly 30 percent of survey respondents who had been enrolled in the new Medicaid program were not aware that they had been signed up. About three-quarters of those enrollees reported that the state had not told them they needed to sign up, suggesting that people did not receive, did not read, or did not understand the state's letter, according to the report.

In addition, enrollees who knew they had to select a benefits plan had trouble doing so, it found. Few respondents estimated the correct number of plans available when surveyed and a majority said it was both hard to understand information about the plans and that it was hard to pick a plan. Even more—60 percent of Duval County respondents and 71 of Broward County respondents—worried about making a bad choice, according to the report. Fewer than half of respondents received help in selecting a plan, and roughly one of five of those who sought additional guidance were unable to receive any.

Nearly half of the U.S. population has limited health literacy, the report found, but making "sound decisions may be an even greater challenge for Medicaid populations, as research indicates that advanced age, limited formal education, and poor health status—characteristics common among program recipients—are associated with poorer health literacy," it said.

If Medicaid enrollees choose the wrong plan, they could face serious financial and medical consequences. Simply to qualify for Medicaid, enrollees must be low income and, according to the report, 42 percent of Duval County respondents and nearly 50 percent of Broward County respondents struggled to pay housing and utility bills in the previous year. If people mistakenly choose a health plan not reflective of their needs, the report notes, affording care on their own would likely be quite difficult.

"The success of consumer-choice models such as that being tested by Florida's Medicaid Reform demonstration hinge on the ability to translate complicated health care information for consumers, and then help consumers use that information to make informed health-care decisions," the report concluded. "Without a well-informed consumer, a fundamental piece of the competitive model is missing, jeopardizing hoped-for efficiencies and cost savings. Further, if recipients are enrolled in health plans that do not meet their health care needs, they are at risk for having problems obtaining needed care, which could have major health consequences."

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