Medicaid managed care fails to deliver

By Laura Goodhue
FL CHAIN executive director
When the Florida Legislature approved the Medicaid Reform experiment in 2005, it was designed to put insurance companies in charge of health care services for Medicaid-eligible Floridians in five counties.

Medicaid Reform promised a vibrant, competitive marketplace where participating insurance companies would each offer different benefits and prescriptions. Floridians would have a choice, and insurance companies would compete against each other for enrollees.

Nearly four years later, evidence shows that this experiment has failed to meet the original goals of Medicaid Reform and, in some cases, hurt the people it was supposed to help. In fact, insurance companies have let down the state of Florida and its people.

Under Medicaid Reform, insurance companies got permission – known as a “waiver” – from the Bush administration to veer away from the amount and types of prescriptions and health care services that Florida Medicaid requires.

The federal waiver also allowed them to add benefits, making plans more attractive to enrollees in a competitive marketplace. That never happened. A year into the experiment, reports surfaced that insurance plans were actually reducing benefits. Few of them added benefits as envisioned.

The counselors the State set up to help people get the information they need to make an informed choice of plans failed time and again. Furthermore, most of the insurers didn't even post basic information about their plans – even though this was required of them by the State.

Since late 2008, 8 insurance companies in two of the counties packed up and left because they weren’t making enough money. More than 200,000 people have been forced to switch health plans to date, and many of them were forced to change doctors and medications as well.

Even worse, at least one insurance plan pocketed money that was entrusted to them by the Florida Legislature to provide health care services to Floridians. WellCare executives were charged with fraud and forced to repay Florida $80 million for mental health services they never delivered.

Today, the same plans that failed Floridians now want to take over our State’s entire Medicaid program. Proposals in the Florida Legislature call for expanding the waiver for another three years and to force more counties and more groups of vulnerable Floridians into the Reform experiment.

Can insurance plans be trusted?