By Lynn Hatter
http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-985594.mp3
Tallahassee, FL –
A federal waiver granted to Florida back in 2006 allows managed care companies to operate the Medicaid program in five Central and South Florida Counties. Lynn Hatter reports Florida is trying to renew its pilot waiver for another year, but is getting hung over negotiations on how and where Medicaid money is spent. Those have implications in the state's plan to for a statewide Medicaid Managed Care program and whether it can get the federal government's approval.
Florida wants to get out of the business of running Medicaid. The state is trying to turn the program over to private healthcare companies. Six years ago, it started the move by creating a five-county pilot program to experiment in Medicaid managed care. The federal government had to approve the pilot, and now it's time for a renewal. But now the feds want a guarantee that 85-percent of the Medicaid money is going to actual patient care, something called a Medical Loss Ratio. Gregg Mellowe is with the Florida Center for Fiscal and Economic Policy. And he says the feds insistence on the MLR is not unreasonable.
"There have been concerns over the lack of accountability in the pilot project throughout its five years. And the concerns that they've had have not been resolved. I think that's universally recognized. CMS has said look, you're getting a waiver, all these federal rules relaxed, so in exchange for that we need some basic assurance that the power given to managed care plans is not going to be abused."
Earlier in the year the legislature approved a plan to take Medicaid Managed Care statewide. It would turn the entire 22-billion dollar program over to private healthcare companies. Lawmakers say this will reign in cost. But the legislature didn't take the Medical Loss ratio into account in its statewide plan. Instead, they chose what's called an Achieved Savings Rebate. It's a revenue-sharing system allowing healthcare companies to keep up to five percent of whatever profit they turn. Anything above that has to be split with the state. Dr. Michael Garner Heads the Florida Association of Health Plans. He says healthcare companies prefer the Achieved Savings rebate.
"Minimum loss ratios don't help contain healthcare spending growth, or ensure that healthcare services are appropriate or billed accurately. Or address directly the quality, efficiency of healthcare service delivery."
Garners cites a report by the American Academy of Actuaries. The report also says the cost of monitoring the loss-ratio could fall to insurers and regulators.
State Senator Joe Negron is the architect of Florida's statewide Managed Care plans.
Sound- "There are going to be a lot of areas where the federal government and the state government see the world differently. We all knew this was one where there would be a disagreement."
Negron says he's focused on the bigger picture.
"As long as there is a good-faith negotiation and they're not commandeering our budget, dictating unilateral terms of surrender. .. I've always said that's going to occur. There will be other issues and there will be some that we feel strongly, and don't want to cut."
So, talks between the state and the Federal Centers for Medicaid and Medicare Services continue. The deadline to approve the state's pilot waiver is September 15. The statewide expansion is still being negotiated as well. Supporters of keeping the Achieved Savings Rebate say the negotiations are a work in progress, and they'll keep pushing the federal government to allow them to implement their own plan.