Embargoed Until:
October 14, 2008
10:00 a.m. Eastern Time



Christopher Fleming

Many Florida Medicaid Reform Enrollees Lacked Key Information About Medicaid Changes, Leading To Reported Difficulties With Choosing A Health Plan

Bethesda, MD -- Florida's Medicaid Reform program aims to encourage consumer choice and market competition by giving health plans new authority to vary benefits and having enrollees choose among the different plans. However, about three in ten enrollees were not aware that they needed to make this health plan choice, and more than half of those who were aware reported difficulty with making a plan choice. These findings were released today in a Web Exclusive article published in Health Affairs, based on the Kaiser Family Foundation's 2006/2007 Survey of Florida Medicaid Beneficiaries conducted during the first year of the state's reform effort.

Three-quarters of the enrollees who were unaware of their need to choose a plan said that they had not been told so by the state -- suggesting that they either did not receive, did not read, or did not understand the state's letter and other communications about their transition, conclude the study's researchers at the Urban Institute, the Kaiser Family Foundation, and the University of Florida.

"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 authors write in the article. "Without a well-informed consumer, a fundamental piece of the competitive model is missing, jeopardizing hoped-for efficiencies and cost savings."

In 2006, Florida became one of the first states to implement a competitive consumer-choice model in its Medicaid program, beginning with a pilot project in Broward and Duval Counties. Florida's program allows private health plans to offer Medicaid enrollees a choice of plans with different benefit packages, rather than offering a uniform state-determined Medicaid benefit package. Several other states (Idaho, Kentucky, and West Virginia) also have implemented elements of benefit variation or consumer choice in their Medicaid programs.

The study surveyed enrollees in the two pilot counties during the first year of the Florida Medicaid reform program. The survey found that more than four in ten enrollees overall appear to have been assigned to a reform plan by the state, rather than reporting making a conscious decision based on the options available to them.

Given that the state's reform affected enrollees with limited incomes and significant health problems, including people with physical and mental disabilities, it is important for them to be enrolled in a plan that meets their health needs. Yet the survey findings on health literacy suggest that many may find making a plan choice difficult; indeed, more than half of enrollees reported being unaware of choice counseling services available to help them.

Among the group who were aware of their need to make a new plan choice under reform, more than half said that they found it hard to understand information about plans, including roughly two-thirds of adults with disabilities in the two pilot counties. Similar shares reported difficulty with picking a plan. Fewer than half reported that they had received help in choosing a plan, and about one in five said that they had tried but been unable to obtain help.

The Kaiser Family Foundation, in collaboration with the Urban Institute and the University of Florida, is conducting a follow-up survey in Florida to continue to track the experiences of Medicaid enrollees in the reform program.

The article, Florida's Medicaid Reform: Informed Consumer Choice?, was written by Teresa Coughlin, Sharon K. Long, and Timothy Triplett of the Urban Institute; Samantha Artiga and Barbara Lyons of the Kaiser Family Foundation; and Paul Duncan and Allyson Hall of the University of Florida. When the embargo lifts, the article will be available online at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.6.w523 or http://www.kff.org/medicaid/kcmu101408pkg.cfm.

In addition, the Kaiser Family Foundation released a separate policy brief that provides an overview of the Florida Medicaid reform and a summary of available research findings to date from various evaluators of the program. The brief, Florida Medicaid Reform Waiver: Early Findings and Current Status, is available online at http://www.kff.org/medicaid/7823.cfm.


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


©2008 Project HOPE–The People-to-People Health Foundation, Inc.