By Tom Flanigan
http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-959412.mp3
Tallahassee, FL – The Florida House Appropriations Committee was also wrestling with the matter of Medicaid during its Thursday meeting. Tom Flanigan reports two bills moving the state's Medicaid program into the world of managed care appear on a fast track.
Today, there are nearly three million Floridians who are served by Medicaid. That's a joint state/federal program that provides health care for low-income people. It costs the State of Florida more than twenty billion dollars a year, or just under a third of the total state budget. For several years, the state has been trying to figure out how to reduce that cost without significantly cutting the quantity and quality of service. About six years ago, Florida began an experiment in what's known as managed care for Medicaid patients in a number of selected counties. Ultimately, those counties would include Baker, Clay, Nassau, Broward and Duval. Patients there would receive Medicaid services through health maintenance organizations.H-M-Os. Florida's Agency for Healthcare Administration, called "AHCA" for short, found managed care did save money versus the traditional Medicaid situation where a patient would go to any doctor or any hospital and the program would pick up the tab; an arrangement called "fee for service." So now the Florida Legislature is looking to move the statewide Medicaid program into managed care. Republican Representative Rob Schenck of Spring Hill is proposing the House's version of the plan.
"Medicaid is created as three managed care programs in one. The first part is the Medicaid Managed Medical Assistance program, which is the primary and acute care portion. The second portion is the Long-Term Managed Care Program. And the third portion is the Managed Care Long-Term Care for persons with developmental disabilities."
Schenck chairs the House Health & Human Services Committee. He had brought two managed care bills before the House Appropriations Committee on Thursday.
"Statewide managed care plans have the following characteristics: care and services are provided through managed care plans: including both HMOs and provider service networks; a limited number of certified managed care plans will be selected through a competitive procurement process that uses specific selection criteria; rates paid to these plans will be negotiated as part of the procurement process, but risk-adjusted to reflect the medical needs of the plan's enrollees."
The bills Schenck brought to the committee closely follow managed care Medicaid bills that were proposed by the Florida House last year, but didn't make it out of session. There are a few differences, though. For administrative purposes, the new bills divide the state into eight regions instead of the original six and there are up to forty-five different health care plans allowed. Schenck says his bills also back off on one topic that drew a lot of fire from opponents.
"Another big change from last year's bill that probably all of you heard a lot about from providers, from everybody, is mandatory contracting. There is no mandatory contracting in this bill. Instead, there are a set of parameters to be followed to ensure that all essential providers will be in each network."
There's little debate that managed care tends to result in cost savings. But one speaker before the committee, Ann Swerlick with Florida Legal Services, had concerns about where the money goes that is spent.
"We're nearly at three billion dollars of public funds that are going to Medicaid HMOs in this state. And many of those are for-profit entities. And what we want to ensure is that at least a certain percentage of that money is actually spent on direct health care services."
Jacksonville Representative Mia Jones, a Democrat, offered an amendment that would cap H-M-O administrative costs. Representative Schenck said it wasn't needed.
"The greatest amount of profit that the plan can share under this where the medical loss ratio is 85. With the profit sharing it's 92 percent and that's for plans that meet that exceedingly high standard quality of care, so I would argue that this is not only redundant but the profit share model actually keeps control of these costs better so I'd urge you to vote it down. Thank you."
The Jones amendment did fail. She also had a question for Representative Schenck about how Medicaid patients in outlying areas might obtain their medicine.
"One of the areas of last year's bill included a specification for community pharmacies located in rural areas and I could not find it in the bill and I wanted to know where it is in the bill?"
Schenck: "Thank you. No, that's because that's been in no version of the bill this year."
Jones: "That's not included in the bill this year?"
Schenck: "No, not included in the bill this year."
More questions followed including one final one from House Minority Leader Ron Saunders, Democrat from Monroe County.
"Is there a significant fiscal impact or not? If we pass this bill today as amended, we'll be taking it to the floor out of the Appropriations Committee, which is the budget committee, without knowing the fiscal impact of the bill. And to me that's inappropriate; I don't think we should do it and at this point I'd like to TP the bill until our next meeting."
Saunders' request to T-P, that is "temporarily postpone" the debate, didn't pass muster with the majority. The two bills, one moving Medicaid to managed care and the other giving the state's Agency for Healthcare Administration the go-ahead to do it, passed and will head to the House floor.