Florida legislators seem poised to pass a bill during its coming session aimed at reducing the state's Medicaid expenditures by expanding privatization of the program, but that may not get federal approval.
The Republican Legislature wants to put more of the state's nearly 3 million Medicaid recipients into privately managed care, expanding a 2006 pilot program implemented under former Gov. Jeb Bush that affects five counties -- Broward, Duval, Baker, Clay and Nassau.
Gov. Rick Scott's health and human services transition team also last month recommended a statewide expansion of the pilot program, although Scott has expressed support for a plan that would give Medicaid patients vouchers to find their own health insurance. Florida's Medicaid program cost about $18 billion during the last fiscal year, with the state paying $8 billion and the federal government footing $11 billion. The cost is expected to rise to more than $20 billion during the current fiscal year.
The federal Centers for Medicare and Medicaid Services is working with the state, but says it's unlikely it will expand the pilot program in its current form amid widespread patient and doctor complaints. Medicaid primarily provides medical coverage for the poor.
CMS likely won't make its decision until June when the current federal waiver allowing the pilot program expires -- well after the Legislature's March 2 to May 6 session ends.
"This has been a controversial waiver with so many issues expressed by advocates about access and quality of services," CMS spokeswoman Mary Kahn told The Associated Press. "We'd have to take a very, very close look to make sure those concerns can be addressed and make sure that Medicaid beneficiaries can best be served by extending the waiver."
Even if federal officials extend the waiver, it could include much stricter oversight, including numerous federal approvals to meet requirements along the way, said Greg Mellowe, policy director for advocacy group Florida CHAIN. For example, he said CMS could require the state to get approval each time lawmakers want to expand into another county or region.
"There are more than enough concerns about the state's performance with the current waiver to call into question whether even expanding the existing pilot will be smooth sailing upon approval of the waiver extension," Mellowe said.
It's also unclear whether the waiver would allow the state to push special populations, including pregnant women and the developmentally disabled, into managed care, as lawmakers are hoping. Those populations are among the most expensive to treat and it's more cost efficient to pay an HMO a flat rate than to pay for each service.
That leaves a lot of lingering questions about the fate of Florida Medicaid recipients -- even if lawmakers agree on a bill.
Legislators had the power to expand the privatization experiment statewide last year, but couldn't reach an agreement.
Officials have said expanding Medicaid privatization to 19 counties, including Miami-Dade, would save about $58.7 million.
Critics worry for-profit providers are scrimping on patient care and denying medical services to increase profits. Five years into the pilot program there's little data showing whether its small savings stem from providers offering less care or because they're delivering it more efficiently.
And physician advocacy groups say several doctors have dropped Medicaid patients in the pilot areas because HMOs refused all the tests and medicine they prescribed. Broward County officials, alarmed by patients who say they aren't getting needed care, tried to pull out of the pilot program but didn't have the authority.
Both Republican and Democratic lawmakers are crafting bills to increase accountability for providers and penalties for dropping out. That's been a complaint for Broward patients after roughly a dozen plans left the program because they couldn't turn a profit. Patients say it's been a nightmare navigating the paperwork each time they're dropped and switched to new doctors.
"We're not going to allow that. We're going to require them to post performance bonds and if they don't want to stay we're going to keep the money," said Republican Sen. Joe Negron, who chairs the budget subcommittee on health and human services appropriations.
Republican Rep. Denise Grimsley said the House is working off last year's bill, which said plans could not participate unless they agreed to operate in both rural and urban areas to ensure equal access for patients.