House proposes changes for health care
TALLAHASSEE - State House lawmakers proposed Tuesday to let private companies oversee the care of nearly all of Florida's 2.7 million Medicaid beneficiaries, but force those companies to spend most of the government money on patient care.
Already one of the biggest cost drivers in state government, Florida's complex, $18 billion Medicaid program is poised to grow steadily over the next decade as federal health care reform expands eligibility criteria. That has the Florida House and Senate aggressively pursuing large-scale, long-term proposals to cut costs by further privatizing the program.
The state has been gradually replacing traditional Medicaid, which compensates doctors and hospitals for each visit, with HMOs and other forms of managed care. The latter model, which pays a pre-negotiated monthly rate, offers predictability and potential cost savings, though critics argue that it encourages skimping on care and provider reimbursements.
In January, the Agency for Health Care Administration reported 1.3 million beneficiaries were enrolled in Medicaid managed care plans, compared with 800,000 receiving direct fee-for-service coverage. MediPass, a state-run primary care plan that resembles fee-for-service, serves an additional 556,000 people.
The plan that a House panel released Tuesday evening would abolish MediPass and direct fee-for-service, except in rare cases, such as legal aliens eligible for emergency services only. For the first time, seniors in nursing homes, as well as people with developmental disabilities, would have to enroll in managed care plans.
The concept builds on an existing - and controversial - Medicaid managed-care pilot project approved in 2005 for five southern and northwestern Florida counties. Last week, the Senate adopted a state budget proposal for the coming fiscal year that counts on savings next fiscal year from expanding the project to 16 counties, including Hillsborough, Pinellas and Polk.
The House version, which the Select Policy Council on Strategic & Economic Planning released Tuesday, would initially save money in the fiscal year starting July 1 by folding Miami-Dade County into the existing pilot project this year. After that, however, the state would begin a five-year process of contracting out Medicaid statewide to managed care organizations.
The plan would carve the state into regions and limit the number of Medicaid managed-care organizations operating in each to no more than 10. Those contracts would last five years.
The House proposal also would change the current system by restricting how much state money the Medicaid managed-care organizations can pocket as profit. The companies and organizations would be required to spend 80 percent of the premium they receive on health care for patients.
The proposal faces opposition from hospitals and doctors complaining the bill would force them into signing contracts with HMOs, making it harder than ever for Florida to retain and recruit medical professionals.
Nonprofit groups advocating for seniors and people with disabilities also sounded alarms, arguing that the needs of those people are not served well by one-size-fits-all, managed-care approaches.
Policy council Chairman Dean Cannon, R-Winter Park, said he expected complaints but was undeterred. The proposed bills, he said, "represent the end of a system that is controlled by special interests. We will eliminate from statute the carve-outs, the preferences and the special deals."
The committee took no votes but expects to send the proposal to the full House for consideration next week.
Reporter Catherine Whittenburg can be reached at (850) 222-8382 or email@example.com.