Florida Medicaid and SCHIP Waivers

Florida Medicaid Reform Waiver – In October 2005, Florida received approval for its Medicaid Reform waiver.  The waiver does not expand eligibility; however, it makes significant changes to the program. The Florida Medicaid Reform began in June 2006 in two counties and expanded to three additional counties in July 2007. The aim of the reform is to move the Medicaid program from being a defined benefit to a defined contribution program. The state provides a risk-adjusted payment to managed care plans. The increase in payments to the plans is capped at 8 percent per year. The program also created Enhanced Benefit Accounts, which reward beneficiaries for healthy behaviors (such as taking children to well-child checks or participating in a weight management program). The rewards can include up to $125 credit at a local pharmacy for health-related supplies such as bandaids or aspirin. In addition, beneficiaries can opt out of Medicaid and direct Medicaid premiums to employer-sponsored insurance. Individuals covered under the Medicaid Reform proposal have their choice of managed care plans and benefit packages.  As of February 2008, over 196,000 individuals were enrolled in Florida’s Medicaid Reform program.