By Lynn Hatter
http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-960548.mp3
Tallahassee, FL – A plan to shift almost three million low-income and disabled people from Medicaid into managed care is closer to reality. Lynn Hatter reports that a Senate Committee has unanimously approved the controversial proposal.
The sponsor of the plan in the Senate is Joe Negron, a Stuart Republican. He says the current Medicaid system, which is based on a fee-for- service plan is broken and expensive, and people who use Medicaid are often labeled and shut out of the healthcare system.
"They feel like they have a big "M" stamped on their head that says Medicaid' and in many cases they're treated as second-class citizens because they are not able to find the care they're entitled too."
The continuing economic slump in Florida has brought more and more people into Medicaid, and the system is currently a third of the state's budget and growing. Negron says by transitioning patients into a managed care system, the state can save money, and make the healthcare system more open to Medicaid recipients. Under his proposal those people could also take their Medicaid money and use it to purchase a different insurance option. And, in order to get more doctors to accept Medicaid patients, the Senate is upping reimbursement rates.
"Starting in 2013 we will pay primary care doctors 100-percent of the Medicare rate. Right now the average is between 54-56 percent. That will have a dramatic effect on improving access to care and making sure Medicaid patients can get in to see the doctors."
But debate on the proposal shows there are plenty of things left to be ironed out. For example: How will the state treat low-income people who need help getting to the doctor's office? Right now, the Senate's bill includes transportation as a service covered in the managed care system. But the House plan doesn't. And proposals in both chambers exempt a wide swath of people from managed care, as Democratic Senator Eleanor Sobel points out.
"Only specific disabilities are listed, that's what's referred to in this statute. Those that are exempt are autism, mental retardation, Cerebral Palsey and Down Syndrome. But there are a host of other disabilities where we need to protect people in these cases. What about those people?
Groups that are exempted will stay on the traditional fee-for-service model, because a one-sized treatment, like what would be provided under managed care, may not work for them.
The Committee spent most of its time going through different amendments to the proposal, leaving little time for public comment. But one couple who did get to speak, Jorge and Debbie Garcia- Bengochea, drew attention to a provision in the Medicaid overhaul bill that limits liability claims for subcontractors operating under managed care systems. The Garcia-Bengochea's adopted two children ten years ago who were placed in a foster home by a community-based service provider where they were abused.
"We had to take care of these children when no one else would. When these providers knew what was going on and basically said we don't have to take responsibility for them, they're yours now. And we had to wait for ten years and go through the whole claims bill procedure because we couldn't get help and we couldn't get the support we needed at the time."
Bill Sponsor Joe Negron says the reason the liability caps are in the bill is to and create an incentive for providers to treat more Medicaid patients. He's looking to strike a balance between what's good for the provider and what's good for the recipient of care.
" There's a delicate balance between protecting the rights of individuals to seek redress for their injuries while at the same time making sure there are insurance policies for them to make claims against so we're trying to maintain that balance and I am sure we're going to continue to work on that as we go forward."
But Debbie Garcia-Bengochea says she doesn't see middle ground on the liability issue, especially when it's a subcontractor who has failed to do its job.
"If someone did that to your child, and raped them and beat them and tortured them and starved them, and put them in a cage in the backyard and duct-taped them, there wouldn't be too many people who would say, well should they be held accountable for what they did to my family?' It's easy to look on the outside of that and go, I don't know, is there some middle ground?' When it's your family there is no middle ground."
The bill cleared the Senate panel and now heads to Negron's Health and Human Services Committee. But any change to Medicaid still has to get federal approval. A process that concerns Republican Senator Jack Latvala of St. Petersburg.
"What happens if we don't get the waiver with this bill? What's our backup strategy if we don't get the waiver?
Negron says if the state doesn't get the waiver it will run its own Medicaid program. But he thinks the federal government will give Florida what it wants, and points to states like Arizona and Maine that have already received Medicaid waivers.
"So I'm very optimistic, given the I -budget approval and these other two that I've mentioned, that the federal government will work with us. We're going to give them 100 reasons why they should work with us to make sure this program is run in a way we can all be proud of."
Meanwhile, the House is set for a floor vote on its version of the Medicaid overhaul proposal. The chamber will most-likely pass it, setting up an extensive debate between the two bodies to work out differences between the two bills.