By John Kennedy
The News Service of Florida
After hearing pleas for caution from more than 20 health care organizations, a House council Monday approved legislation that would dramatically overhaul Florida’s $19 billion Medicaid system, steering virtually all its 2.7 million patients into managed care programs over the next five years.
The move helps set the stage for likely end-of-session negotiations with the Senate over crafting a new Medicaid program, which would bear little resemblance to the traditional, fee-for-service plans that have dominated the past 40 years.
“There’s plenty of time; two to three weeks in the legislative session process is more than plenty enough to work out the differences,” said Rep. Dean Cannon, R-Winter Park, chairman of the Select Policy Council on Strategic and Economic Planning, which approved the House Medicaid plan, divided into two bills.
Democrats joined Republicans in approving the measures almost unanimously.
But representatives of groups that provide developmentally disabled services, home-health care equipment, and advocates for nursing home residents were among those urging that lawmakers study the plan for another year before acting — perhaps opening the historic rewrite to more public review.
“If we could just take some time, let’s not stick one plan on top of another,” Katie Porta, of Quest, Inc., told the council. Quest provides services to those with developmental disabilities and operates group homes in Central Florida.
Karen Woodall, who lobbies for low-income programs, said, “I think a lot of our concerns are that this is a massive change affecting the lives of our most vulnerable residents.”
Rep. Gary Aubuchon, R-Cape Coral, shrugged off calls for delay, pointing out the plan already provides a five-year phase-in, with long-term care for the elderly and services for those with developmental problems the last to take effect.
“If we studied this for the next 10 years, there’d still be pieces of it people didn’t like,” Aubuchon said. “This really sets the platform for transitional reform.”
The House went public with its proposal for the first time last week – days after the Senate approved its approach, which extends a five-county managed care pilot project to 19 additional counties, including some of the state’s most populous.
The Senate also wants to pursue a federal waiver to craft a Florida-only Medicaid plan, requiring patients to meet co-payments, deductibles and capping payments for some services.
As ambitious as the Senate plan initially appeared, the House plan goes farther.
The House would give HMOs, provider service networks (PSNs) and other managed care plans authority to compete to serve low-income patients, with the state divided into six Medicaid regions. The plan would be phased in over five years, with the first step coming in July when Miami-Dade County would be added to those five counties with managed care.
Currently, more than half of Medicaid patients are in managed care. But the House plan would require that all 2.7 million in the program – 14 percent of the state’s population – enter a managed-care system that even proponents of the legislation acknowledge is not in place statewide.
Miami-Dade has been targeted for reform by lawmakers since it’s seen as the nation’s epicenter for Medicaid fraud. Home health care agencies in the county, for example, draw close to half of the almost $200 million Florida spends on claims for these services – despite the county only containing about 20 percent of the state’s Medicaid population.
With 80,000 Medicaid service providers statewide, Florida officials acknowledge their system is likely pocked with fraud and waste. But HMOs and PSNs are expected to have a profit motive to weed out waste.
PSNs have been credited by University of Florida analysts for reducing per-patient costs in Broward, Duval, Baker, Clay and Nassau counties, where the pilot reform began in 2006. But analysts also have said it has been difficult to determine whether the costs were reduced through efficiencies or because health care services have been reduced.
