HB 7225 Summary: Medicaid Reform

• iBudget Demonstration Project: Establishes individual budget (iBudget) system for developmental disabilities Medicaid waiver services in specified counties (Escambia, Okaloosa, Santa Rosa, Walton), using allocation algorithms based on client needs with full implementation by January 1, 2013.

• Medicaid Managed Care Expansion: Expands managed care pilot program to Miami-Dade County by October 1, 2012, requiring all eligible Medicaid recipients to enroll in qualified plans with risk-adjusted capitation rates phased in over three years.

• Medical Home Networks: Authorizes Agency for Health Care Administration to designate qualified plans as medical home networks to provide coordinated primary care and care management for recipients with chronic illnesses and frequent service utilization.

• Provider Enrollment and Requirements: Authorizes Medicare crossover-only provider enrollment, requires providers to report Medicare suspension/disenrollment within 5 business days, and mandates prepaid dental health plan contracting.

• Structural Changes: Reorganizes Florida Statutes by designating Medicaid sections into three parts (Social and Economic Assistance, Kidcare, Medicaid), repeals Long-Term Care Community Diversion Pilot Project provisions, and renumbers certain statutes effective October 1, 2012.