By Lynn Hatter
http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-958246.mp3
Tallahassee, FL – The legislature is a step-further in an overhaul of Florida's Medicaid program after a House Committee approved a plan that would gradually shift the recipients of Medicaid into managed-care plans. As Lynn Hatter reports, the state is hoping to save at least a billion dollars if the program is successful.
Five years ago the state created a pilot project in five counties. Instead of the fee-for service system that traditional Medicaid is based on, patients were shifted into managed care networks, where health care providers work together to reduce costs. One of the counties that had the program was Broward. And during the House Health and Human Service Committee meeting, Democratic Representative Elaine Schwartz talked about what happened when Medicaid managed care came to her county.
"There was no transparency in the Medicaid reform pilot, which is an experiment, and the experiment failed. And it didn't fail for lack of requirements for the law. It failed for lack of penalties in not following the law. One of the problems we all know, was that so many of the plans dropped out."
That caused thousands of people to lose their insurance. And one of the reasons the plans left was because of low reimbursement rates. Many doctors and other health care providers don't treat Medicaid patients for that reason. And Broward County Commissioner Barbara Sharief worries patients will have even less access to care if the state goes ahead with its plan to expand the pilot program.
"There's no profitability in serving the Medicaid population unless companies limit their risk. How do healthcare companies limit their risk? They limit eligibility, limit access and limit services. And what happens when we limit services and access to care, especially in communities where patients are being discharged quicker and sicker? Patients become ill, and they return to the most expensive care available, which is hospitals and emergency rooms."
The state's Medicaid program has seen an increase in enrollment as the economy has slumped and people have lost the health insurance they had under previous employers. Lawmakers expect Medicaid to cost about 20-billion dollars next year at a time when the state has a budget deficit. And opponents to the plan like Democratic Representative Mark Pafford of West Palm, say his Republican colleagues are putting money over people.
"We're not really taking things into consideration that will improve quality and access. And I know that we're going to hear that quality and access will improve, but quite frankly, I tend to disagree. I think it's a 20-billion dollar amount of funds that we're going to turn over to private managed care. There's a question of whether any of that will be under the sunshine once its delivered into their hands. And there's a question of whether profit will be a main consideration or quality of care."
But Republican Representative Gayle Harrell of Port St. Lucie says right now, Medicaid patients' access to providers is already low, and the shift to managed care would actually improve health outcomes.
"There's no preventative care right now in our Medicaid system. Patients do not get what they need to prevent illness or deal with chronic illness. We have no management of the care of the patient. This is about managing care, as well as managing cost."
The house's plan calls for the state to be divided into seven regions that will have a select number of providers that Medicaid patients could choose from. There will have to be enough Medicaid recipients in each one to make the plans financially healthy. The proposal changes the way the state divides up more than a billion dollars in funding that goes to hospitals that treat low-income and uninsured people. And a spokesman for the Safety Net Hospital Alliance of Florida told the committee the change could result in a 125-million dollar hit for teaching and children's hospitals. That got the attention of Representative Ronald Renuart, who has some concerns.
"And I will support this bill going forward. But I think there are still some adjustments that need to be made in other stops. And I think the regions and also protecting our safety net hospitals are the most important changes."
The bill does represent a change from what the state is currently doing with Medicaid, and Naples Representative Matt Hudson says it's about moving Florida forward.
"If you want to remain in the status quo, then you shouldn't be here. That's not what the legislature is about. The legislature is about looking forward to the future of Florida, not looking backward. We have to maintain our traditions but we cannot be ham-stringed by poor thinking. So I leave you with this thought. The problems that exist in this world cannot be solved by the level of thinking that created them."
The Medicaid proposal still has several stops to make and a similar plan is working its way through the Senate. If the plans make it to the floors of both chambers, there are differences between them that have to be ironed out. And the state still has to get approval from the federal government before it can enact the changes.