FMA: Fixing Medicaid will require a multi-pronged approach

By Jarrod Fowler, MHA, FMA Director of Health Care Policy and Innovation

Recently, the Biden administration announced that Medicaid enrollees will be subject to new appointment wait times, a component of network adequacy standards. However, network adequacy standards alone will not optimize Florida’s Medicaid program. Florida already has some network adequacy standards in place, which are listed below. However, even with additional funding from the Legislature, lower Medicaid rates have remained a barrier to accessing care in Florida. The FMA is very grateful for this additional funding and hopes that it will help alleviate this problem while work continues to be done to ensure access for these vulnerable beneficiaries.

The way Florida physicians view Medicaid is illustrated by the results of the Florida Department of Health’s Physician Workforce Annual Report, which was last updated in 2023. As you can see, a plurality of physicians who do not accept new Medicaid patients do so due to low reimbursement rates.

Source: Florida Department of Health

In addition, more than a quarter of physicians who have patients with Medicaid but do not accept new Medicaid patients do so because of low reimbursement.

Source: Florida Department of Health

As you can see from the tables below, plans are supposed to maintain adequate networks. If you find that your plan does not maintain an adequate network in accordance with these standards, please let us know so that we can reach out to the Agency for Health Care Administration. Working to ensure that plans are held to their contractual standards and that patients can access care is crucial to our members and their patients, and we want to hear your feedback. But until reimbursement and network adequacy standards are both fully addressed, along with the state’s healthcare practitioner shortage, we can expect to have an imperfect system.