Florida Medicaid reform will need reforming: Don’t just expand managed care. It would be too much like right for the Legislature to try creative solutions for the state’s burgeoning Medicaid crisis. Instead, legislators are ready to take the expedient way out, by expanding statewide a five-county test program that even state analysts say isn’t working.
Since 2009, because of the economy, the number of Floridians on Medicaid has gone from an average of 2.4 million per month to nearly 3 million. Bills in the House and Senate would force Medicaid patients into managed care programs that ostensibly would save the state money. Studies by the University of Florida and The Associated Press, though, found flaws in the test program.
The Senate bill, crafted by Republican Joe Negron of Stuart, does improve on last year's version by offering consumer protections, such as requiring managed care organizations to spend at least 90 percent of revenues on health care. The federal Affordable Care Act requirement for insurers is 85 percent. The Senate would pay doctors at 100 percent of Medicare rates, which are significantly higher than existing Medicaid rates. That would increase access. The measure rightfully would exclude from managed care the developmentally disabled and seniors in nursing homes. The House version has no such exclusions.
Critics have assailed the Senate measure for capping the amount that can be spent on each patient, but the state's resources are not infinite. "Medicaid benefits are extraordinarily generous," Sen. Negron said. "We're trying to create a Medicaid benefit comparable to what someone in the private sector receives."
The worst part of the Senate bill, which should not be in any final legislation, would allow Florida to withdraw from Medicaid if the federal government does not grant waivers for statewide, mandated managed care. Florida then would be responsible for the entire Medicaid bill, leaving many without care.
Of the $20 billion the state expects to spend on Medicaid next year - up from $14.8 billion in fiscal 2008, when the financial crisis hit - $12 billion comes from Washington. Medicaid supports "our hospitals, our nursing homes, our communities," said Laura Goodhue, executive director of Florida Community Health Action Information Network, which opposes the reform bills. "It would have a huge multiplier effect if we lost that money."
The House bill would make the transition to statewide managed care over five years, beginning in July 2012. That makes far more sense than the Senate's starting point of December. Both bills would allow networks sponsored by doctors and hospitals to compete with HMOs. Given the bad track record of HMOs in the test program - several pulled out when they couldn't make a profit - this change is essential. The Senate version would let accountable care organizations also compete. Such groups have a track record of saving money and improving health outcomes.
Medicaid is the second-biggest item in the state budget, after education, and reform will be one of this year's biggest bills. Since the basic premise, statewide managed care, is faulty, legislators should take the best of each bill, then prepare to start over again if it turns out that they were wrong.
