A House health-care committee on Monday, March 14, began debating a proposal to overhaul Medicaid, amid questions about how to carve up the state geographically into a managed-care system.
The House proposal would split the state into seven regions where HMOs and other types of managed-care plans would compete to win Medicaid contracts.
But some lawmakers and interest groups raised repeated questions about whether that roadmap would work, particularly in rural parts of the state.
For example, Rep. Janet Cruz, D-Tampa, said one proposed region would stretch from Pensacola to Madison County in north-central Florida --- raising the possibility that patients might have to travel hundreds of miles to see a specialist in a health plan.
Conversely, Rep. Mia Jones, D-Jacksonville, said Broward and Miami-Dade counties would be placed in different managed-care regions. She said that could affect patients who might travel across the county line to see doctors or other providers.
But House Health and Human Services Chairman Rob Schenck, R-Spring Hill, said each region needs enough population to make the system financially viable for health plans. He acknowledged that will require some changes, such as in where patients are referred for care.
"This is a new day in Medicaid and managed care, so there are going to be some changes,'' Schenck said.
As an incentive to try to get managed-care plans to compete in rural areas, the bill includes a sweetener: If plans do business in the Panhandle, they also will get contracts for heavily populated Miami-Dade and Monroe counties.
"Certainly, the Panhandle is the most-challenging aspect of this, because of the rural nature of it,'' Schenck said.
Carving up the state is a fundamental issue as House and Senate lawmakers move forward this spring with a Medicaid overhaul that would place almost all beneficiaries into managed-care plans. The Senate has proposed another geographical approach, slicing the state into 19 smaller regions.
Michael Garner, president of the Florida Association of Health Plans, said his HMO group has not taken a position on how many regions should be used.
But Ralph Glatfelter, a senior vice president of the Florida Hospital Association, suggested using about a dozen regions. The hospital industry wants to create what are known as "provider service networks" to compete with HMOs, which could be easier in smaller geographic areas.
House and Senate leaders have vowed to pass a Medicaid overhaul, as they try to rein in the cost of the $20 billion health-care system. The chambers have released widely differing proposals and will have to negotiate a compromise in the coming weeks.
The House Health and Human Services Committee on Monday spent about two hours discussing its proposal and taking testimony. The committee is scheduled to vote on the proposal, which is spread over two bills, on Thursday.
Along with the geography issue, the debate touched on a wide range of issues, including whether the proposal would allow managed-care plans to limit services to patients, how the plans would be held accountable --- and whether the state should even be expanding mandatory managed care.
Rep. Elaine Schwartz, D-Hollywood, pointed to problems in a managed-care pilot program in Broward, Duval, Clay, Baker and Nassau counties and said she thinks going statewide could turn into a disaster.
"I'm very, very concerned it's really not ready for prime time,'' said Schwartz, a frequent critic of the pilot program, which began operating in 2006.
But Schenck said the new proposal includes improvements over the so-called "reform" pilot.
Among the frequent complaints about the pilot is that some HMOs pulled out of the counties, causing upheaval as Medicaid beneficiaries had to switch plans.
The new proposal calls for managed-care plans to sign five-year contracts and includes penalties if they leave an area early.
"This is a much-improved plan,'' Schenck said.