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Senate unveils medicaid reform proposal

By James Call

Tallahassee, FL – The Florida Senate wants to save money in the Medicaid program by moving millions of patients into managed care programs. The proposal is in a comprehensive reform plan that divides the state into 19 regions and invites private companies to bid on serving patients in the region.

Senator Joe Negron is the Senate's point man on Medicaid reform.The health care program for the poor and elderly serves nearly 3 million people and consumes nearly half of the money raised by the state sales tax. Negron wants to control costs by moving away from paying for each medical procedure separately and into a managed care model. Critics say it is easy for vendors to steal money in the current massive fee for service system. Experts rank Miami-Dade and Broward as the two top counties in the nation for Medicaid Fraud. Senator Negron.

"We believe the private sector will do a much better job at getting rid of fraud at managing things more efficiently than the current system. You have 80 thousand providers, you have AHCA making over a hundred million payments per year and you have a situation pay and chase and by the time you get to the people they are on to some other scam."

Nearly a third of Florida children and more than 60 percent of nursing home residents are covered by Medicaid. Its budget this year is 20 billion dollars and it is expected to continue growing on what lawmakers call an unsustainable trend. Negron proposes several steps to rein in costs. One is a spending cap. When presenting the plan he noted that Medicaid is the one budget item that lawmakers appear to have no control over.

"We don't get a bill from the Department of Transportation going you know what? I don't know what happened but we built a lot of extra roads that you didn't appropriate for so you need to I don't know what happened we just things went crazy we got the guys and the ladies on the crew and they just cut some extra roads and so, sorry that things got out of hand could you us a bill? We're not doing that any more. We're going to decide how much we spend on Medicaid. We are the appropriators, and we're saying the state agencies that work with us and implementing they do not have the authority to spend beyond what we appropriate."

The proposal would require many, not all, recipients to pay a 10 dollar monthly premium, pay a 100 dollar fee to receive non emergency services at a hospital emergency room, for overweight people to go on a diet and smokers and alcoholics to seek treatment. The key component though is the move to a managed care system. It would require companies to bid on five year contracts to provide whatever medical care a patient may need and enable the state to hold the vendor accountable. The plan would need federal approval and Negron is confident Florida will get it. If not he has a timeline to withdraw from the federal Medicaid program and create a Florida version.

"We need to gain control of the Medicaid budget here in Florida. And we're going to give the federal government 100 good reasons to continue to work with us as partners in the bill in the delivery of Medicaid and as legislators we never are going to abandon Florida's most vulnerable citizens. We are simply asking the federal government for some reasonable flexibility."

Senate Democratic leader Nan Rich said that much of Negron's proposal gives her heartburn. She noted if the federal government rejects Florida's request for a waiver and the state were to secede from the federal Medicaid program it would create a crisis. Washington currently contributes about 12 billion dollars to the program.

"I understand that you are saying we'll take care of our nursing home and we will take care of certain parts of the population but ultimately we would not be able to manage what would happen out there without a full Medicaid program. I agree with you that the federal government is going to be flexible but I would also urge us to be flexible."

Negron has initiated what will be a spring long discussion in Tallahassee about how Florida provides medical care to the poor, elderly, disabled and catastrophically sick. Republican leaders in both the House and Senate say reform is a priority. Speaking after Negron presented the plan to the full Senate, Senate President Mike Haridopolos told senators that Negron's proposal is a first step. That the bill would be sent to three committees and Haridopolos invited the public to participate in the debate by email, phone calls and in person during committee meetings.

"We look forward to this debate. This is a challenging debate but it is not unlike every other major state in the union is facing. We encourage everyone to participate and I think through the participation process we've already made real gains and we are putting accountability measures so that patient quality is at the top and not costs at the top."