[UPDATE] Senate Rolls Out Medicaid Reform Details

By: Kathleen Haughney, The News Service of Florida; AP
By: Kathleen Haughney, The News Service of Florida; AP

[UPDATE] 2-16 Noon --

The Florida senator taking the lead role on changing the Medicaid system released on Tuesday tidbits of what a comprehensive overhaul will look like this year, saying the state will push more patients into managed care, expand the I-Budget program for the developmentally disabled and potentially chip away at optional services for recipients.

To make many of the envisioned changes, the state would need permission from the Obama administration. And that doesn’t come, said state Sen. Joe Negron, R-Stuart, the state will try to pull out of the federal Medicaid program.

“If the federal government elects not to allow us to manage the program they way we believe is in Florida’s best interest, then we’ll operate our Medicaid program with our resources,” Negron said.

Lawmakers have been tinkering with Medicaid reform for years, with the Florida House releasing a reform package last spring focusing on the expansion of managed care that the Senate could not agree to by the end of the legislative session. Florida’s $20 billion Medicaid program serves 2.9 million people, but lawmakers have said the program is eating up the state’s budget and both the Republican-led House and Senate have made it one of the top legislative priorities for 2011.

Lawmakers have made it clear they want to shift most Medicaid recipients into a managed care plan where most would be covered by a private health maintenance organization, or HMO.

However, the plan would make two exceptions, excluding the developmentally disabled from mandatory managed care and also allowing objectors to the state plan to receive a set amount of money to choose their own health plan.

The Senate’s decision to exclude the developmentally disabled and expand the iBudget, which creates individualized budgets for recipients depending on their needs, was a major victory for the developmentally disabled and their families, who have been in Tallahassee lobbying lawmakers for the past few months.

Laura Mohesky, a Melbourne-based care aide who has accompanied developmentally disabled adults and family to Tallahassee to speak to lawmakers, cautioned legislators earlier in the day that though managed care may save some money, it may decrease the quality of services that are crucial to the disabled population.
She pointed to the example of diapers, noting that a managed care plan may be able to find her Medicaid recipients less expensive items, but they would be of cheaper quality, which could cause some health problems.

“I guarantee you, I’m going to be looking at a lot more skin break down,” she said.

Other proposed changes include making a Medicaid recipient see a primary doctor within 30 days of enrollment, increasing reimbursement rates for doctors, and requiring that 90 percent of the money goes toward patient care and not a health plan’s administration costs.

The health plans are carefully watching how lawmakers will ultimately define patient cost versus administrative costs. For example, a HMO might call a nurse hotline patient care, but other medical professionals might define it as an administrative cost.

“We’re very much concerned with how it’s defined, how it’s applied and how it will work,” said Michael Garner, president of the Florida Association of Health Plans.

The proposal, which Negron said will save the state $4.3 billion over three years, is set to be released Thursday morning giving the public its first chance to see precisely how the Senate proposes to change the system. He said he hopes the proposal will be convincing enough for the federal government to get behind Florida’s plan to change the system.

Florida lawmakers have threatened to withdraw from the federal program before, but that would mean forfeiting the majority of the money the state gets to treat the poor – and might not be allowed by federal officials anyway.

Karen Woodall, a longtime social services advocate, said she found it hard to believe that the Senate would propose giving up a huge chunk of federal money.

“If the feds don’t approve that and we (try withdrawing), we could be losing billions of dollars, billions and billions of dollars,” she said.

Negron said he is continuing to take input from lawmakers and that there will be plenty of opportunity to amend the bill.

The Senate will also likely continue to look at which optional services – those not required by the federal government to be covered - should be paid for in Medicaid, such as dental and vision services.

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Tallahassee, FL (AP) - State senate leaders say they will not put Medicaid patients with developmental disabilities and those in nursing homes into managed care.

Sen. Joe Negron said Tuesday those populations will be given an "I budget," allowing more flexibility in their medical care.

The emerging Senate bill also proposes raising the reimbursement
rate for primary care doctors up to 100 percent of Medicare rates.

Senate leaders say they will likely cut some optional services for the state's nearly 3 million Medicaid patients. Senators will release what services they want cut on Thursday.

Sen. Nan Rich said Medicaid patients make $799 or less a month
and can't "go out and get a policy and afford dentures and glasses."

Lawmakers said the state's Medicaid budget is expected to reach $21 billion next year.

(Copyright 2011 by The Associated Press. All Rights Reserved.)


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