“Under the waiver, Florida will establish ‘a maximum per year benefit limit’ for each recipient and fundamentally change its role. The state will largely be a buyer rather than a manager of health care.

In an interview, Alan M. Levine, secretary of the Florida Agency for Health Care Administration, estimated that no more than 5 percent of Medicaid recipients would hit their annual limits. At that point, Mr. Levine said, ‘the health plan will still be responsible for providing services to the consumer, but the state’s reimbursement would be limited to that amount.’

Asked whether the beneficiary would be responsible for paying costs beyond the limit, he said: ‘That can happen today. There are arbitrary limits and caps embedded in the state Medicaid program, limits on home health services, doctors’ visits, prescription drugs.’

For each beneficiary, Florida will pay a monthly premium to a private plan. Insurance plans will be allowed to limit ‘the amount, duration and scope’ of services in ways that current law does not permit.” (New York Times )