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Caution Urged as House Moves to Overhaul Medicaid

By: Margie Menzel, The News Service of Florida
By: Margie Menzel, The News Service of Florida

THE CAPITAL, TALLAHASSEE, Feb. 08, 2011

There’s broad agreement that the state’s
Medicaid system for providing health care to the poor is too expensive, often illogical, and on its way to being completely overhauled.

But that’s where the agreement generally ends, and this year’s legislative look at the issue provides another glimpse into why big change is slow. Nearly everyone involved urges caution, not speed.

As the state shifts more of the responsibility for making decisions about care of the poor to private managed care organizations the caution signs come from patients:

“HMOs will continue to deny and deny [services],” Laura Joslin, owner of Ability Plus Therapy in Melbourne and mother of two sons with developmental disabilities, said at a House hearing on Tuesday on the effort to revamp the system. “That will create another layer of difficulty for that child to get continuity of care, which is incredibly important.”

But pleas for caution also come from providers.

Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, said a statewide expansion of privatized care would likely leave one-fifth to one-quarter of residents in hard-to-serve areas. “The best road may not be perfection at the beginning,” he said. “If you try to do everything up front, it’s going to create problems.”

And so the slog continues toward trying to “fix” a Medicaid system that policy makers have complained about for years. Still, while everyone pleads for careful deliberation, there is widespread agreement that the state must alter the current system, which cost nearly $20 billion last year, just under half of which the state is on the hook for. With Florida’s budget more than $3 billion in the red, some of the caution may have to give way.

“We’re going broke,” said Dr. Joseph Tepas, a trauma surgeon in Jacksonville. “We’ve got to make a change. I think everyone understands that.”

The hearing Tuesday in the House Health & Human Services Quality Subcommittee was the second public hearing on changing the system this year.

With costs poised to soar another $2 billion this fiscal year, the Legislature wants to put more of the state's 2.9 million Medicaid recipients into privately managed care, expanding a 2006 pilot program implemented in Broward, Duval, Baker, Clay and Nassau counties. Although lawmakers tried to expand the privatization pilot last year, they couldn't reach an agreement.

Gov. Rick Scott hopes for dramatic changes, and quickly. His proposed budget released this week relies heavily on Medicaid savings to make it balance.

The House expects to have a Medicaid bill by the end of February. For now, it is essentially working off last year’s bill, which would have reduced Florida's Medicaid expenditures by expanding privatization of the program over the next five years. Ultimately, lawmakers couldn’t come to an agreement on last year’s proposal.

It would have had managed care plans and provider service networks competing for Medicaid patients around the state.

Tuesday’s hearing drew representatives of Florida hospitals, HMOs, emergency physicians and medical services, surgeons and pediatric care facilities – many of whom warned that the overhaul would have unintended consequences for their patients.

“In Broward County, we experienced Medicaid reform first,” said Broward County Commissioner Barbara Sharief, a pediatric nurse practitioner. “Hospitals and urgent care facilities are releasing patients into the community quicker and sicker….There has to be a way to decrease services based on safety and not cost.”

When services are cut in the home care setting, said Sharief, as she frequently sees, patients often return to the hospital.

Tepas, the Jacksonville surgeon, and a governor of the American College of Surgeons, said the reform effort has to look at making outcomes better, not just saving money.

“I don’t necessarily believe that this bill – or the one that will follow it – will be the switch that we turn that makes everything well,” Tepas said. “Rather, it’s the next step in the transition….The ultimate accountability is patient well-being.”

The House has another committee hearing set for Wednesday on the Medicaid revamp effort.


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