Medicaid Overhaul Completed ?

Council approves Medicaid overhaul

By Jim Saunders
4/12/2010 © Health News Florida

A House panel today approved a proposal to overhaul Florida's Medicaid system and gradually require low-income, elderly and disabled recipients to move into managed-care plans.

Two votes by the House Select Policy Council on Strategic & Economic Planning started a week that will be filled with debate about the Medicaid program, which legislative leaders say is unwieldy and too expensive. The Senate passed a different managed-care plan but has scheduled more than nine hours of committee meetings Wednesday and Thursday to consider the House proposal.

"Medicaid in Florida, I think we all agree, needs improvement,'' said Lake Placid Republican Denise Grimsley, who played a leading role in drawing up the House proposal.

The council voted 16-1 to approve the primary bill that would move almost all Medicaid recipients into health-maintenance organizations and provider-service networks over a five-year period. That includes requiring managed care for seniors who need long-term care --- including nursing-home care --- and people with developmental disabilities.

The panel also voted 15-1 to approve a companion bill that would add Miami-Dade County to a pilot program that requires managed-care enrollment for many Medicaid recipients in Broward, Duval, Nassau, Clay and Baker counties. The Miami-Dade addition is scheduled to be completed by June 30, 2011, making it the most-immediate change in the House proposal.

Lobbyists for a wide range of groups raised concerns today about the House proposal. That included representatives of groups that provide services to people with developmental disabilities, such as low IQs, autism or cerebral palsy.

Ron Silver, who represents the Carlton Palms Educational Center in Lake County, said lawmakers should focus on the quality of Medicaid services and not only on cost. He described Carlton Palms as serving the "most severe of the severe'' people with developmental disabilities.

"Let's go and dig deep into how the people are going to be affected, how the families are going to be affected, how the community is going to be affected,'' said Silver, a former longtime lawmaker.

The hospital industry also objected to part of the proposal that would require hospitals to contract with HMOs. Ralph Glatfelter, a senior vice president of the Florida Hospital Association, asked the council to remove the requirement, which hospitals argue would reduce their bargaining power.

With Medicaid costs expected to top $19 billion next year, lawmakers have spent weeks looking at ways to rein in the program. The House proposal would divide the state into six regions and use a competitive process to choose a limited number of managed-care plans to serve each region.

The managed-care requirement for long-term care services would take effect by Oct. 1, 2012. The requirement would apply to the broader Medicaid population in 2013 and to developmental-disability recipients in 2015.

Any Medicaid changes would need agreement between the House and Senate. Senators have passed a plan that would expand the five-county pilot program to 19 additional counties, including major metro areas such as Miami, Orlando, Tampa and St. Petersburg.


--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at jim.saunders@healthnewsflorida.org.