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Critics say medicaid managed care could lead to less competition

By Lynn Hatter


Tallahassee, FL – Lawmakers have approved proposals steering more than 2.9-million Floridians into managed care networks. Lynn Hatter reports bills heading to the governor's desk seek to save money and mitigate future costs, but plenty of doubts remain about what will happen to the people who use those services and the organizations that provide them.

The plan to change the state's Medicaid plan from a fee-for-service model to managed care is far from a done deal. A lot of people will be affected, from insurance carriers, to the businesses that treat them. And not everyone is happy about the switch. Jim Croteau is the President of Elder Care Services, Incorporated.

"The big impact across the state will be that the traditional local providers will now have to work with big, for-profit HMO's who are moving into the business, so to speak."

Croteu's organization is a non-profit that provides services like Meals on Wheels to seniors who aren't sick enough to be in a nursing home, but still need help to stay in their own home. He says under the changes to the Medicaid program heading to the governor's desk, his organization could lose a million dollars.

"Now, I've got 150 clients that we're serving with the Medicaid waiver program. Managed care will take those over in October of 2013, and if we continue to work with them, we'll have to be a contract with managed care who will take their profit and their administration costs off the top before they contract with us."

That's because the legislature wrote the bills in a way that gives larger companies top priority in getting state contracts. The logic there is that the bigger the company, the more resources it has, and the more access patients will have to doctors. The legislature is also hoping the state will save the state a billion dollars the first year the plan is in place. Senator Joe Negron worked on the proposal for more than two years. He says in addition to saving the state money, it's about giving people more choice, not less.

"And we're not telling you what to do. We're respecting your decision on what you want to do with your healthcare and we're saying that, if you think you can find a better deal somewhere else and Medicaid is not for you, you can take the money that we were going to spend on your care as a stipend and find another plan. And we're fine with that."

The legislature's plan to steer more than 2.9-million Floridians on Medicaid into managed care networks gets rid of current fee-for-service model and gives the money to healthcare companies to treat patients instead. That's sparked worry that small, regional plans, independent physicians, nursing homes, and other medical providers could be forced to either join a larger network, or be priced-out. And the healthcare companies don't deny that possibility. Dr. Michael Garner is the head of the Florida Association of Health Plans.

"There are a couple of different options but most providers, if they want to continue serving Medicaid patients, will have to do it as part of the networks."

The state has to ask the federal government for a waiver to go through with its plan. Garner says if the state doesn't get it on the first try, that doesn't mean the plan will be scrapped.

"I can't think of any waivers submitted to the federal government that need to be modified to some extent. And if the federal government does require us to make modifications to get the larger program operational, I think the legislature will consider that on a point by point basis and decide if they want to accept that requirement."

Meanwhile, Elder Care Services head Croteau remains skeptical.

"The state has objected to ObamaCare as they government telling people what they do, but then they turn around and have given low-income people no choice in the fact that they now have to go into managed care, and for-profit HMO's for the most part are going to determine the level of care."

And that, he says, is a double-standard.