HB 7223 Summary: Medicaid Managed Care

• Establishes a statewide integrated managed care program for all Medicaid covered services, including long-term care, with mandatory enrollment for most Medicaid recipients except those with only family planning, breast and cervical cancer, or emergency alien services.

• Creates three distinct managed care programs: Managed Medical Assistance (implementation by October 1, 2013), Long-Term Care Managed Care (implementation by October 1, 2012), and Managed Long-Term Care for Persons with Developmental Disabilities (implementation by October 1, 2015).

• Divides Florida into six regions for plan procurement and requires the Agency for Health Care Administration to select a limited number of qualified plans (3-10 depending on region) through competitive invitations to negotiate, with special consideration for provider service networks and medical home networks.

• Establishes comprehensive plan accountability requirements including medical loss ratio thresholds (85-92% spending requirements), provider network standards, encounter data reporting, quality performance measures, and penalties for early plan termination or enrollment reduction.

• Guarantees recipient protections including 30-day initial choice period, 90-day disenrollment window, choice counseling services, and "good cause" disenrollment provisions for quality of care issues or service access problems.