[Nfbf-l] {Disarmed} Proposed Fl Medicaid

[Kirk]

Senate Medicaid bill would cap costs, use HMO-like plans
By Aaron Deslatte, Tallahassee Bureau

11:41 AM EST, February 17, 2011

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TALLAHASSEE -- The Florida Senate wants to cap soaring Medicaid costs by 
shifting millions of poor and sick people into HMO-like health plans, 
charging for doctor and hospital visits, and banning illegal immigrants from 
getting care through the rapidly growing program.

A reform proposal unveiled Thursday also spells out a time-frame for 
seceding from the health-care plan by the end of 2011 if the federal 
government doesn't approve the cost-cutting measures.

The reform, which dramatically expands the state's 2005 reform pilot project 
in Broward and several Northeast Florida counties, got its first of what are 
likely many hearings Thursday as lawmakers grapple with how to contain 
soaring costs. The House has yet to unveil its own version, but Republican 
leaders in both chambers have made it a mission this year to cut costs in 
the swelling entitlement program.

Last year's House plan carved up the state into six regions and would have 
required managed-care companies to bid on serving patients in the entire 
region. The Senate plan breaks the state into 19 regions, giving HMOs more 
flexibility to target more lucrative populations.

The core concept behind the push would be to stop paying locked-in fees for 
each medical procedure. Critics say that "fee for service" system leads to 
over-utilization of health-care and rampant fraud.

Instead, for-profit health-maintenance organizations, physician networks or 
other managed-care organizations would be paid capped dollar amounts to 
treat people, theoretically containing costs in a program that has swelled 
to cover 2.9 million people at a cost of more than $20 billion this year. 
The changes are being billed as a way to shave $1 billion off next year's 
projected $22 billion price-tag for the program.

"We want to get out of the check-writing business and into the contract 
compliance business," said Senate Health Care budget chief Joe Negron, 
R-Stuart. "It is a fundamental shift."

The five-year-old pilot project in Broward was launched by then-Gov. Jeb 
Bush, and has produced mixed results. Studies have suggested it did contain 
costs, but did not stimulate much private-market competition and created 
some confusion among patients. The experimental project excluded seniors --  
who are among the most expensive patients to care for - while the new plan 
would include them.

Democrats Thursday expressed misgivings with putting seniors into HMO-like 
companies that have a financial incentive to shift elderly patients into 
more costly nursing homes.

"I really believe managed care is not the way to go for this population," 
said Senate Democratic Leader Nan Rich, D-Weston.

But Republicans said the reform allowed other options besides just HMOs, 
such as doctor networks that might be willing to participate.

"If this were only an HMO bill, I would vote against it. I would be on the 
other team," said Sen. Don Gaetz, R-Niceville.

Among the Senate bill highlights:

It would require most of the state's 2.9 million Medicaid patients to be 
shifted into managed-care plans through companies like HMOs. Some 
populations would be excluded from mandatory enrollment, including the 
developmentally disabled; nursing home residents; women eligible only for 
family planning services, breast or cervical cancer services; and sick 
children.

The reform would limit Medicaid eligibility to legal residents, and could 
require patients to pay a $10 monthly premium and take smoking-cessation or 
weight-loss classes.

It limits people in the Medically Needy program to receiving only physician 
services and renames the program the "Medicaid Non-poverty Medical Subsidy 
Program."

Parents who are above the federal poverty limits could have to pay a 
"sliding scale" of fees for their children to be covered.

Doctors who treat Medicaid patients would be reimbursed at 100 percent of 
the Medicare rates, which is roughly double what they get now.

Medicaid patients would have to make a $3 co-pay for specialty physicians 
and a $100 copayment for non-emergency services provided by a hospital 
emergency room.

The plan also spells out a timeline for breaking out of the state-federal 
Medicaid program if the federal government does not approve the changes by 
the end of 2011.

If Florida breaks away and the feds stop paying their majority-share share 
of the $20 billion program, the state would prioritize services for nursing 
home care, pregnant women, doctor and hospital visits, and babies or 
children in state custody.

Negron said he was encouraged that the federal government would work with 
the state because it was allowing others like Arizona to start dropping 
benefits.

"We're not asking to do outrageous things. We're asking to do common-sense 
things ... that are going on every day in businesses," Negron said, calling 
it "extremely doubtful that the federal government would not work with us."

If the federal Department of Health and Human Services does not OK the move, 
he said, "we'll continue to run our program in Florida with the resources 
that we have."

adeslatte at tribune.com or 850-222-5564.





Kirk Harmon
President & CEO
Florida Disabled Citizens
for Progress
P.O.Box 61794
Jacksonville, FL 32236
PH(904) 783-9896
Cell: (407) 473-2176
DAV/BVA
Life Member

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