More than a decade ago, Florida made a bold decision to transform how health care is delivered to its most vulnerable Medicaid beneficiaries. By shifting from a fragmented, fee-for-service model to a single, coordinated system of care managed by Florida’s health plans, the state has improved health outcomes for Medicaid members and reined in costs for taxpayers.
This transformation continues to yield results for Floridians. Today, more than 4 million Floridians receive care through Medicaid, with the vast majority – 78% – receiving their health care from one of Florida’s health plans. This single coordinated system, known as the Statewide Medicaid Managed Care (SMMC) Program, has demonstrably performed above the national average, kept members satisfied with their services and controlled costs.
In fact, recently, the Agency for Health Care Administration (AHCA) presented on the performance of the SMMC Program before Florida policymakers. Part of that presentation included how, across key quality benchmarks, Florida outperforms the national average in key health focus areas, including:
— Improving birth outcomes: While Medicaid covers 46% of all births in Florida, the state’s pre-term delivery rates (2020–2023) have remained lower than pre-pandemic levels and below the national average each year. Florida ranks in the top 25% of states for women receiving postpartum care. Primary cesarean section rates have also improved since 2019 and remain below national averages annually.
— Reducing preventable hospitalizations and emergency room Visits: Potentially preventable hospital readmissions have fallen to 65.9 per 1,000 admissions, and avoidable ER visits remain below pre-pandemic levels.
— Improving children’s health: Covering 48% of Florida’s children, Florida’s Medicaid health plans outperform national benchmarks on well-child and preventive care, ranking in the top quartile nationwide.
— Managing chronic disease: Florida Medicaid ranks in the top 25% of states for asthma control in children, cervical-cancer screening, and weight counseling for kids and teens, with above-average diabetes management.
— Improving access to behavioral health care: 30-day follow-up after mental-health hospitalization has steadily improved since 2021, and Florida is among the top states for medication treatment for opioid-use disorder.
Equally important to quality, members report high satisfaction with the care they receive. AHCA’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey found that 74% of adults and 84% of parents rated their plan highly overall. In comparison, 73% of adults and 87% of parents gave high marks to the quality of care their families received.
Florida’s health plans are also leading in long-term care, helping more seniors and people with disabilities live independently at home. Since the start of the SMMC Program, the share of long-term-care members residing in the community has risen from 40% in 2014 to 67% as of mid-2024. Quality measures within long-term-care plans continue to perform at exceptional levels – with 94% of members receiving comprehensive assessments, 95% completing person-centered care plans, 87% having care plans shared with their primary physician, and 98% screened for fall risks. Just as importantly, 82% of members and caregivers rate their case managers and care teams highly, underscoring that high-quality, coordinated care improves both outcomes and satisfaction.
Collectively, this data demonstrates that Florida’s health plans are improving health outcomes by proactively engaging members in care and providing critical supports and resources to help them lead healthier lives, which in turn, effectively controls health care costs for the state of Florida.
As we move into the future of the SMMC Program, Florida’s health plans remain committed to our shared mission of providing access to high-quality, affordable health care and continually improving outcomes to build a healthier Florida together.
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Brittney Hunt is Chief Executive Officer, Florida Association of Health Plans.