Florida Considers Adding ‘Exclusive Provider Organization’ Option Under Medicaid

To control costs under Florida's Medicaid program, the state is weighing the addition of a new type of managed care plan, called an exclusive provider organization, or EPO, the Orlando Business Journal reports. Florida's Medicaid program, which costs the state about $10 billion per year, requires beneficiaries to choose either a Medicaid managed care plan or traditional Medicaid, which is called Medipass in Florida. State Rep. Frank Farkas (R), vice chair of the state House Health and Human Services Appropriations committee, said, "The Medipass model is very expensive. And there are some areas in the state where there are no Medicaid HMOs available, so patients have no choice" but to enroll in Medipass. Of the state's 1.8 million Medicaid beneficiaries, about 550,000 are enrolled in a managed care plan. To save costs and offer patients another managed care option, the state is considering an EPO, a less-restrictive option than an HMO. The Business Journal reports that under an EPO plan, Medicaid will cover care for beneficiaries only if it is provided by doctors within a network. The Business Journal does not report additional information on how an EPO plan differs from an HMO plan. Farkas said, "This would be a good compromise. We're trying to give Medicaid patients the ability to contract with doctors who might save [the state] money" (Lundine, Orlando Business Journal, 12/7).