Heading to Feds, Florida Medicaid Package Unveiled

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By JIM SAUNDERS
THE NEWS SERVICE OF FLORIDA

THE CAPITOL, TALLAHASSEE, August 2, 2011...Florida's Medicaid overhaul would not start shifting people into managed-care plans until 2013 and would use a controversial pilot program as a springboard, according to hundreds of pages of documents released Tuesday.

The documents are Florida's detailed proposal for carrying out new state laws that would eventually require almost all beneficiaries to enroll in managed-care plans. The state Agency for Health Care Administration sent the proposal Monday to federal Medicaid officials.

Supporters hope the federal government will sign off on the proposal, which they say would help control costs in the $21.2 billion Medicaid program and improve care for beneficiaries.

"What Florida's proposing really is at the vanguard of what states are doing, and a lot of states are looking at Florida,'' said Senate Health and Human Services Appropriations Chairman Joe Negron, a Stuart Republican who was an architect of the plan.

But opponents are worried about requiring Medicaid beneficiaries statewide to enroll in HMOs or other types of managed-care plans. Some, including Democratic legislative leaders, want the federal Centers for Medicare and Medicaid Services to reject the proposal.

Senate Minority Leader Nan Rich, D-Weston, said she is concerned about the ability of managed-care plans to serve low-income people who have severe medical needs, including seniors who need long-term care.

"In and of itself, it (requiring seniors to enroll in managed care) gives me heartburn,'' Rich said. "Because this is an extremely vulnerable population.''

Lawmakers approved a two-bill package in May, with a goal of moving roughly 3 million Medicaid beneficiaries into the new mandatory managed-care system by October 2014.

AHCA appears to have closely followed the Legislature's direction in putting together the proposal. But the documents also fill in details about how the state would transform the Medicaid system --- and how it hopes to convince the federal government to go along.

As an example, one of the new laws says AHCA will begin "implementation" of the managed-care program for seniors in July 2012. But the documents make clear that seniors would not start enrolling until early 2013, because of the process of awarding managed-care contracts.

Similarly, the law says AHCA will begin "implementation" of statewide managed-care for a broader Medicaid population in January 2013. But the documents indicate people would not start enrolling until late 2013 at the earliest.

The documents request a series of approvals for what are known as "waivers" to federal Medicaid laws. The state is seeking two new waivers, which are intertwined, so it can require seniors to enroll in managed care.

But the state also is seeking an amendment to an already-existing waiver so that it can require managed-care enrollment for the broader Medicaid population, such as women and children.

That move quickly spurred criticism Tuesday, because the state uses the already-existing waiver to operate a Medicaid "reform" pilot program that requires most beneficiaries in five counties to enroll in managed care.

Democratic lawmakers and some patient advocates have long argued that the pilot is filled with problems.

"What I see is what I think we all expected,'' said Greg Mellowe, policy director for Florida CHAIN, a group that advocates for Medicaid beneficiaries and is highly critical of the pilot and the statewide proposal. "It's mostly a building off the Medicaid reform experiment.''

Negron said he would have preferred to seek a new waiver instead of amending the pilot waiver, adding that some of the pilot's results are a "distraction" from what lawmakers are trying to accomplish with the new statewide system. He said AHCA and House leaders thought it would be better to use the already-existing waiver instead of starting over.

"My first choice would have been to come at this with a clean slate,'' Negron said. "But that's not where we are.''
Michael Garner, president of the Florida Association of Health Plans, however, said the new statewide program will be substantially different from the pilot.

"This is a new law,'' Garner said. "The Medicaid waivers are simply tools for implementing policy.''

Two other proposed amendments to the pilot waiver also are likely to draw heavy scrutiny. Those proposals seek to require Medicaid beneficiaries to pay $10 monthly premiums and to pay $100 if they go to hospital emergency rooms for non-emergency conditions.

Opponents have contended since May that those ideas would hurt low-income people and violate federal Medicaid laws.

But in the proposals to the federal government, AHCA said the ideas were aimed at increasing personal responsibility and stemming the unnecessary use of emergency rooms.

"The Florida Legislature intended that eligibility for Medicaid include certain personal responsibilities on the part of recipients,'' a document outlining the $10 premium said. "The new law includes provisions on participation in activities to promote healthy behaviors and modest financial participation in the program.''

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