Trends in the Quality of Care of Florida Medicaid Managed Care Long-Term Care Program Enrollees Following a Managed Care Roll-out

Background and Purpose: Florida’s Agency for Health Care Administration (AHCA) transitioned from a multi-waiver state-directed Medicaid system to a managed care model using private health insurance companies from 2013 to 2014. As a condition for approving this managed care model, the Centers for Medicare and Medicaid Services (CMS) required that annual independent assessments be conducted to ensure that access to care, quality of care, and the cost of care either remained the same or improved following the implementation. This presentation describes findings from a 5-year independent assessment of the effects of this structural change on the health-related quality of life (HRQOL) of Medicaid enrollees by addressing the following research questions:

1. Are long-term care (LTC) services effective at achieving positive health outcomes?
2. Are LTC services effective at achieving equitable positive health outcomes by gender, race/ ethnicity, and geographic location?

Methods: This study evaluated retrospective longitudinal data from multiple sources, including the federally developed Minimum Data Set 3.0 and the state developed 701B Comprehensive Assessment. Analyses were conducted on the entire population of Florida Medicaid Long-Term Care (LTC) enrollees (N=110,664) over the five-year period (2014-2019). Descriptive parameters, as well as inferential statistics, were reported. Trends in HRQOL indicators (e.g., quality of life, self-reported health, pain, preventable hospitalizations, and vaccination rates) by three locations of care (nursing facilities, assisted living communities, and homes) were reported. In addition, logit models for HRQOL and preventable hospitalizations were reported.

Results: Most HRQOL indicators remained the same or improved over the five-year study period. However, further analyses found that there are differences in Medicaid enrollees’ quality outcomes based on their location of care, race/ethnicity, and geographic location. For example, self-reported quality of life declined for Medicaid enrollees living in assisted living communities and homes over the study period. However, enrollees living in assisted living communities also experienced increased social participation over the study period. Further, inpatient hospitalizations and emergency room visits decreased for enrollees in all locations of care. However, preventable hospitalizations and amputations increased for enrollees with diabetes, especially among Black and Hispanic enrollees. Rates of flu and pneumococcal vaccinations declined in nursing facilities, but this did not appear to affect preventable hospitalizations for bacterial pneumonia. There was also a geographic effect, which reflects varying quality of care that may be attributed to disparities in care provided by the different managed care providers.

Conclusions and Implications: Recommendations were made to AHCA to reduce preventable hospitalizations, specifically those related to diabetes, through financial incentives to managed care organizations. In addition, recommendations were provided to improve the monitoring of quality of care and quality of life of Medicaid enrollees living in homes and assisted living facilities. Lastly, recommendations were made to train managed care organizations’ case managers and other personnel in cultural competence and humility and require additional training focused on anti-racism.