Florida Legislature Passes Medicaid Reform

Florida's changes to federal program will be unique among states
By: Kevin Derby and Gray Rohrer | Posted: May 7, 2011 3:55 AM

Florida's Medicaid program will likely undergo fundamental and historic changes in the coming years, as the state Legislature passed a comprehensive reform package Friday, the last day of the legislative session.


The bill shifts Medicaid recipients from the government-centered program that provides health care to low-income families by paying providers for services, and into managed-care companies that are contractually obligated to provide services and meet cost-reduction goals.


The bill is largely based on a five-year-old pilot program in Broward County and four other North Florida counties, but the statewide move to managed-care companies is unprecedented among the other states.


Lawmakers have long targeted the program for reforms -- funded at $22 billion in the 2011-2012 fiscal year budget, it currently takes up 30 percent of the overall budget. More than 50 percent of the funds come from the federal government.


Senate President Mike Haridopolos and others went on a tour of the state last summer seeking input from citizens on the issue, and the final product passed Friday seeks to provide for more individual freedom and responsibility in choosing health-care services while reducing costs.


"We have very strict controls in place, but I think we should look at Medicaid more in an entrepreneurial way rather than a top-down 'we are the government, this is the way you will do it,'" said Sen. Joe Negron, R-Stuart, who led the charge on Medicaid reform in the Senate.


There is an exception included in the bill for disabled patients, who will receive an "iBudget," or yearly stipend to use for health care.


The bill passed in a 28-11 vote in the Senate and 79-39 in the House along party lines, with Democrats objecting to the reliance on private companies to take care of Medicaid patients.


Negron has stated that the changes to Medicaid will save up to $1.3 billion in the first year, with greater savings in subsequent years. Senate Minority Leader Nan Rich, D-Weston, doubted the promised savings, since there were no definitive cost savings that have resulted from the Broward pilot project.


"This pilot has been in effect for almost five years and at this point we have almost no definitive answer as to its success. I have serious reservations about whether we can throw pretty much all the most vulnerable people -- with the exception of some disabled people -- into managed-care plans," Rich said.


The bill establishes 11 regions in which health management organizations (HMOs) and provider service networks (PSNs), which are comprised of some nonprofit hospitals, are able to provide care. The House originally called for 18 regions, with an earlier Senate version including just 10 regions.


“Our good friends in the Senate suggested many good changes. We have now agreed to 11 regions in the state of Florida," said Rep. Rob Schenck, R-Spring Hill, chairman of the House Health and Human Services Committee and sponsor of the House Medicaid reform bill.


Republicans maintained the reforms would not reduce the quality of care, but Democrats remain unconvinced.


“This bill will reduce the scope and amount and duration of care,” said Rep. Mark Pafford, D-West Palm Beach.


Negron held that the contractual protections and penalties for providers who violate their contracts will help to ensure compliance in the amount and quality of care as well as cost reduction. He admitted that under the pilot project, HMOs left Medicaid patients, but said that wouldn't happen in the statewide reforms.


"HMOs did sign people up and then they did leave, that's absolutely true, but we learned from that. We made sure they wouldn't have to go from plan to plan. If you leave a region against your contract then you're kicked out of every other region that you're in," Negron said.


The bill also caps non-economic liability damages for Medicaid recipients at $200,000 for individuals and $300,000 per incident.


With many of the provisions in the Affordable Care Act, or Obamacare, that will increase the number of eligible Medicaid recipients in Florida by 1.4 million or 1.7 million people, legislators thought it was essential to enact reforms this year. Haridopolos vowed at the beginning of the session to not "kick the can down the road."


Many of the provisions of the Medicaid reform package require a federal waiver to be implemented, but Negron has expressed confidence that the federal government will issue the necessary waivers.


"I don't think we should allow Washington to commandeer our budget and I think they will work with us because they have the same budget problems we do," Negron said during the floor debate Thursday.


Gov. Rick Scott is expected to sign the bill into law.

Reach Gray Rohrer at grohrer@sunshinestatenews.com or at (850) 727-0859. Reach Kevin Derby at kderby@sunshinestatenews.com or at (850) 727-0859.

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7:49AM MAY 9TH 2011
An ounce of prevention is worth a pound of cure. If we don't start at the core, no matter what we do will only be a band-aid on the high cost of health care. And it's only a matter of time when it becomes unaffordable for all those except the very wealthy.

At least 80% of chronic illnesses are diet and lifestyle related. People need to be educated on that and then held more responsible for their choices.

Many of the drugs we prescribe are only better than a placebo, some are downright dangerous and lead to hospitalization, and many have side effects that leads to more doctors visits and more drugs being prescribed.

I've even read a good percentage of surgeries, and medical devices are not worth their cost. That's where comparative effectiveness comes in and is one of the things I like best about "Obamacare".

We also need to stop subsidizing obesity and ill health by cutting out the subsidies to corn, sugar, and dairy.

And since not everyone has the capacity or inclination to read labels we should make it easy by enacting a stoplight symbol labeling law. Every processed food should have a stoplight symbol on the front of it. Green, eat to your heart's content. Yellow, eat with caution either due to too much sodium, sugar, or unhealthy fats (and known carcinogens). Red- stop and think before consuming this food due to higher levels of those health offenders.

We should also put more effort in curbing pollution- both air and water. Air pollution not only raises the rates of asthma and other chronic lung diseases, it also contributes to heart disease.

We should also put more effort into preventing unplanned pregnancies and extra pregnancies for those already on Medicaid.

Among other things...
9:40AM MAY 7TH 2011
Once again, the Florida legislature has attempted to put the screws to people on Medicaid. Have any of them tried to get private insurance anywhere when they find out you're HIV positive? It's impossible.
Have they noticed how hard it is for Medicaid patients to get a specialty doctor? Most of them have left the program which leaves the patients out in the cold.
Didn't anyone in the legislature notice that the "reform" program in place now really isn't working very well??
Managed care is not the answer. So much for the " compassionate conservatives. I challenege any one of them to spend a year or two on Medicaid and see what they think of it then. They may change their mind.
12:30AM MAY 8TH 2011
It all goes back to bieng accountible for your actions. Medicade,Health Insurance etc...will all
go under if we don't continue to try to make the necessary cut backs so that everyone can get some of the benifits they think are they are entitled too! Unfortunetly that money is not a bottomless pit and requires "people" to start taking care of themselves in order to help stop that shift. Bottom line is YOU are responsible for your own health . Occassionally some become ill secondary thinks outside of control
7:09AM MAY 7TH 2011
Didn't our Governor's (Rick Scott) Company receive on of the largest Medicare fraud fines ever? I'm sure he will make sure every dime from the federal government will be properly spent on needy patients.
Stephen Whitmore
6:05AM MAY 7TH 2011
When states use HMOs to provide service to Medicaid patients the states always pay so little that the only way that the HMOs can try to make enough money to satisfy their number one goal (make lots of money) is to make it hard for patients to access services (few, hard to get to, difficult to schedule clinics, few participating hospitals and testing facilities) and they often do not pay vendors or hospitals and physicians when patients crash into non-participating hospitals.
Steve Harrison
7:07AM MAY 7TH 2011
Medicare and Medicaid are doomed to financial failure. The only way to continue is to use private companies that have an incentive to cut costs and make a profit. They also need to hold people accountable and not waste more billions. By the way based on a 3% net profit 97% goes back in to the community. Do you think the government runs that effeciently?
10:01AM MAY 7TH 2011
Government runs on 0% profit. The difficulty with government is the costs of administration. Is there anything in this bill that requires the HMOs to limit (or at least disclose) how much they are spending on administration and how much they are spending on care.
8:46AM MAY 7TH 2011
Steve, an incentive to make people better is important, too.

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