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, but about three in 10 enrollees were not aware that they needed to make this health plan choice, and over half of those who were aware reported difficulty making a plan choice.

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, concluded a study by researchers at the Urban Institute, Kaiser, 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 researchers wrote. “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 10 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 and over half of enrollees reported being unaware of choice counseling services available to help them in making a choice.

Among the group who were aware of their need to make a new plan choice under reform, more than half said 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 picking a plan. Fewer than half reported that they had received help in choosing a plan, and about one in five said 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.

Source: Kaiser Family Foundation