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Florida pushes forward with plan to shift Medicaid to managed care

Florida's Senate Health Regulation Committee unanimously approved a bill yesterday that would shift the bulk of the state's Medicaid recipients into HMOs and other types of managed-care organizations.

The move is the latest step in Gov. Rick Scott's controversial plan to privatize Florida's Medicaid and CHIP programs covering 2.9 million people at a cost to the state of more than $20 billion. A similar GOP-sponsored bill is expected to come to the floor for a vote today in the Florida House.

[See also: Wisconsin announces Medicaid Managed Care contract; Executives group names top 10 challenges for managed care in 2010]

Today's House vote comes after the Republican Majority in the house rejected an amendment in the bill that would have given Medicaid recipients the option of choosing HMO-style managed care or a continuation of the current fee-for-service model. That amendment would also have required managed care organizations that would have set requirements for reporting and accountability and levied penalties for those that didn't meet the requirements.

"I want to protect poor people that are getting Medicaid," said Rep. Mark Pafford, a West Palm Beach Democrat. "Also, it's a great way to ensure that the private managed care folks are accountable with that $20 billion we are going to provide them."

With the Senate set to soon take up, and expected to pass, its version of Medicaid reform there remain some hurdles the state would need to clear before implementation.

First, the state would need to receive a waiver extension from the Centers for Medicare & Medicaid Services to implement the shift to managed care. The state currently has a waiver for a five-county demonstration project examining the effects of a shift to managed care for Medicaid, but that waiver expires on June 30.

In January Gov. Scott sent a letter to HHS Secretary Kathleen Sebelius requesting an expedited decision on an extension of the existing waiver.

"A substantial review including multiple evaluations of the waiver have been conducted and indicated the state has implemented all components of the waiver and has met or exceeded requirements and, in addition, has resulted in improved outcomes and increased satisfaction among participants," Scott wrote in the letter. "CMS approval of the waiver will provide the state with the ability to maintain the program and budget certainty regarding the availability of Low Income Pool."

The letter also cautioned HHS that any waiver granted but with changes proposed by CMS would not be received well, noting that any changes should not represent "micromanagement" and should provide value in administering the program. "As such, CMS should not unilaterally require changes to the program without agreement from the state."

The bill moving through the state Senate includes provisions for moving the program forward with or without a waiver extension. Palm City Sen. Joe Negron, sponsor of the Senate bill, said the state is prepared to renounce the federal government's contribution to the program--a total of $12 billion--in order to move forward with the shift to managed care.

Opponents say basing any new model on the current pilot is a bad idea, since it has failed in many regards. Aaron Elkin, MD, president of the Broward County Medical Association, told the American Independent that the pilot has failed since doctors and hospitals are not available to patients due to hurdles imposed under the HMO model.

Florida Community Health Action Information Network (CHAIN), an advocacy group for Medicaid patients and providers, is urging citizens to lobby their legislators to vote against the measure.

A call to action by Florida CHAIN noted "this risky proposal would put the interests of for-profit companies before those of Florida health consumers and taxpayers. It builds on a failed Medicaid Reform program that has a long list of problems that haven't been fixed including a lack of transparency and oversight. These bills do not offer consumer protections or proven methods of saving Florida money."

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