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Medicaid hearings reveal flaws, potential pitfalls

By Lynn Hatter


Tallahassee, FL – The Florida Agency for Healthcare Administration is conducting public meetings this week and taking input on the state's plan to steer more than 2.9-million Floridians into managed-care plans. About half of those people are already in a pilot program that's operational in five counties. But as Lynn Hatter reports, the state's federal permission waiver is about to expire. And critics are raising doubts about the transition's future.

Florida's waiver to operate Medicaid managed care in five Central and South Florida counties expires at the end of the month, and a letter from the Federal Center for Medicaid and Medicare services says if the state doesn't make drastic changes to the program, that waiver won't be renewed. Florida Hospital Association lobbyist Paul Belcher says the state needs to pay close attention to that letter.

"We believe there are some deficiencies between the two and the first and most apparent one is the issue related to medical loss ratios. There's a profit-sharing component to this program that we believe does not provide adequate patient protection with regards to levels of services."

The medical loss ratio caps how much a company can spend on administration fees versus how much it spends on direct patient care. But a ratio cap isn't in the state's Medicaid overhaul law nor a part of the pilot project extension. Retired reporter turned columnist Les Coleman says that could keep Florida from getting waivers for both programs.

"My source told me in Baltimore that as the law is written now in Florida, the way the legislature passed this law, that a waiver is quote, "unlikely," end quote, from the federal government."

Roberta Bradford is the Medicaid Secretary for the Florida Agency for Healthcare Administration. She says the medical loss ratio is still being discussed.

"That is something the legislature looked at in the document provided by CMS but they did mention they'd be providing additional details on that."

The Medicaid public hearings are continuing throughout the week in different parts of the state. Florida is waiting to hear back from the federal government on a waiver extension for its pilot program, and it has until the start of August to submit waivers to expand Medicaid managed care to the rest of the state.