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Scott signs medicaid revamp into law that makes seniors go first

By Lynn Hatter


Tallahassee, Fl – Lawmakers have at least one major achievement they can put in the history books- approving the most sweeping change to the state's Medicaid program since it began in the 1970's. Lynn Hatter reports the new law would steer about three million Floridians on Medicaid into managed care networks. Florida is looking to save money and mitigate future costs, but plenty of doubts remain about what will happen to the people who use those services.

"And what about this? The Medicaid issue? Where he's privatizing Medicaid? He's already made the decision on who goes into it the state has. And it's the elderly and disabled who are going to go into the HMO's. For profit HMO's..."

Joseph Flynn stands on a sidewalk, across the governor's budget signing ceremony in Central Florida's retirement community, the Villages. He's holding a hot-pink poster and protesting against the legislature's plan to steer more than 2.9-million Floridians into managed care organizations.

"How's it gonna work? You've got people already in nursing homes For-profit companies have a fiduciary responsibility to make money for their stockholders. So they're not going to manage their care, they're going to ration their care. And it's the elderly and the disabled people."

Flynn is a retiree, and he's not pleased with a new law that begins moving Medicaid seniors in nursing homes into programs managed by private healthcare companies. Under the plan, people in those facilities would be entitled to dental, vision and hearing services. Right now Medicaid bills each one separately. More seniors would also be steered into home and community- based programs, reserving nursing homes for the people who need them the most. But Tony Marshall with the Florida Healthcare Association, says he doesn't think the legislature will save that much money in the long run.

"Trying to save money in the long-term care portion of Medicaid is one of the greatest challenges. Every study that has ever been done has indicated that less than one percent of the individuals in a nursing home at any point in time are eligible to receive services in another setting. Because of that its going to be difficult to reduce the occupancy in a nursing home."

Meanwhile the Florida AARP is taking a wait-and-see approach. Spokesman Jack McRay says the managed care industry is making promises to the state that it may not be able to keep.

"The HMO's have said they can do this. I think now that they've been given the responsibility, they'll have to do it. And I think you're going to see the HMO's shuffling a bit about what they're responsible for under the program and I think you're going to see them come back and ask for more money."

But those representing the industry say it can do more with less. Dr. Michael Garner is the director of the Florida Association of Health Plans. He says managed care networks can help solve some of Medicaid's biggest problems, like rapidly increasing costs, fraud and long-term elder services.

"We feel like there's a large window of opportunity there to again transition people out of institutional settings into home and community based services which we know will have one of the greatest effects in reducing overall costs in the budget."

Legislators want to save a billion dollars in the first year of the program by mandating managed care companies cut their budgets by five percent. But not everyone is on board with Florida's plan. John Pollack heads the national healthcare consumer advocacy group Families USA. He says managed care done right is a good thing, but managed care for the sake of saving money through cutting services is worrisome.

"You get a sense that the focus is exclusively saving money instead of improving quality of care. And it gives cause for concern that the kind of managed care system envisioned is designed to withhold necessary care from people."

A study by Georgetown University looked at a smaller version of the program, a pilot project in five counties in Central and South Florida. Georgetown professor Joan Alker says the results don't bode well for the larger program.

"The concern here is that we have some real problems in Florida's pilots, and in particular we've seen a lot of plans coming in and out of the market, we actually saw one of the largest plans, Wellcare, which was found guilty of fraud and abuse allegations. So we need to have really strict oversight of the contracting process to make sure taxpayer dollars are spent well."

Florida's plan to shift millions of Floridians into managed care depends on whether the state gets permission from the federal government. The state has already received a letter from the federal agency that deals with Medicaid, suggesting its plan could be rejected if changes aren't made . But no one seems terribly worried that the proposal will be scrapped all together. Florida Association of Health Plans' Dr. Garner says what's most likely to happen is that the state will make the changes, and resubmit its request to waive the federal rules and do its own thing.

"I can't think of any waivers that are ever considered by the federal government that don't need to be modified to some extent. If the federal government does require us to make modifications, I think the legislature will consider each one of those on a point-by-point basis."

Meanwhile the state Agency for Healthcare Administration is holding a series of public meetings across the state to get feedback on the plan. The next hearing is in Largo, Florida on June 15. The Agency has to submit its waiver to the federal government by August first.