[UPDATE] Medicaid Reform

By: Whitney Ray, Kathleen Haughney Email
By: Whitney Ray, Kathleen Haughney Email

THE CAPITAL, TALLAHASSEE, Nov. 17, 2010 -- Kathleen Haughney --

Desperate to cut into the state’s $20 billion annual Medicaid pricetag, state lawmakers began tossing out ways to cut costs Wednesday, including shuttling more low income patients into private managed care programs and creating new limits on lawsuits against doctors.

Key senators held a six-hour meeting Wednesday on the heels of a non-binding memorial passed Tuesday stating the Legislature’s intent to revamp the state's Medicaid program and touting plans to expand the state’s five-county managed-care pilot program statewide. Since the summer, Senate President Mike Haridopolos and his top legislative lieutenants have been promising to overhaul the system during the 2011 legislative session.

“It’s just a broken system that doesn’t work,” said Sen. Joe Negron, R-Stuart, who Haridopolos named the new chair of the Senate’s Health and Human Services Appropriations Committee and who will spearhead the Medicaid overhaul effort.

Lawmakers, and many health officials, have been saying that for years, though. A massive overhaul that began under former Gov. Jeb Bush resulted in the pilot project, but proponents of expanding the change statewide have run into critics who have said that Medicaid recipients haven’t gotten the quality of service envisioned.

Backers of the changes say Medicaid recipients don’t get quality health care now – in part because so many health care providers don’t accept Medicaid patients, in part because the system is fragmented and doesn’t treat patients systemically, as managed care seeks to do.

Negron, accompanied by other senators and House members from both parties, met with health care officials and members of the public to hear testimony on ways the state could fix the system. Negron repeatedly said the group was working from a blank slate, but he laid out some topics that he wanted lawmakers to consider including lawsuit limits, higher physician reimbursement rates, better use of community based organizations for care and major changes to the Agency for Health Care Administration.

“My goal is that every Floridian have a primary care doctor,” he said. “They need to know where they get their care from.”

State economists predict for the 2011 fiscal year that Medicaid will cost $20.2 billion and serve 2.9 million people. However, Republican state lawmakers are predicting the new federal health care law will vastly expand the system.

To make any major changes to the Medicaid system, including expanding the pilot program, the state would have to get a Medicaid waiver approved by the federal government first.

The political framework surrounding a Medicaid overhaul could be tricky as well, with various groups all wanting their part in a rework of the program. During Wednesday’s meetings, 19 different interest groups testified, ranging from HMO representatives to community health departments to physicians and the AARP.

The issue of lawsuit reform also raises political hackles, with politically-connected trial lawyers often working to block limits damages.

The meeting also peaked the interest of different local health advocates, particularly in the community of activists for the developmentally disabled, who asked whether lawmakers could ensure that a managed-care system would guarantee Medicaid waiver recipients the same level and access of care that they are currently receiving.

Laura Mohesky, a case worker in Brevard County who came to Tallahassee for the meeting with other developmental disabilities advocates, said that with little information about how a managed care system would function, many people were worried that people could lose services. Mohesky told lawmakers she did not understand how they could provide Medicaid recipients with the same budget if they go through a managed care operator, who would likely want to make a profit.

"It doesn't make sense to me,” she said. "I have a hard time thinking you're going to give managed care the same budget you have now and they aren't going to want to profit from that. There's no way we should be profiting from any of these individuals ."
Negron said he is not working on any sort of set timeline to produce legislation for the Senate’s consideration, but that he would like all of the different parts of the overhaul to be a part of one bill, rather than a package of measures. The House has not begun work on its proposals either.

Tallahassee, FL -- Whitney Ray --

Four disabled Medicaid recipients greeted lawmakers, lobbyist and health care administrators with a sign Wednesday as they made their way to talk about Medicaid reform. Inside a caseworker assisted Patrick Wells as he told state senators how Medicaid helps him out of a group home and living on his own.

Caregiver: Do you need help to live there?
Patrick: Yes
Caregiver; Does somebody come in everyday and help you?
Patrick: James.

Lawmakers want to move Medicaid recipients into private managed care providers like HMOs to help cut the 20 billion dollar cost to the state. Aaron Nangle runs a company helping disabled people find caregivers. He says the move would leave his customers without vital services.

“Are they really going to put through the care, the effort? Are they going to advocate for the individuals with disabilities,” asks Nangle.

Besides privatizing parts of the entitlement program, lawmakers also want to cut down on rampant Medicaid fraud, and protect doctors from malpractice lawsuits.

Federally funded health clinics, like Bond Community Health Center in Tallahassee, already enjoy protection from lawsuits. Dr. Temple Robinson, the center’s medical director, says eliminating the threat of being sued lets doctors practice more freely.

“That was the physicians, the providers here do not pay malpractice premiums out of pocket,” said Robinson.

Whatever decisions are made by lawmakers will be met with criticism, but if the cost aren’t lowered, economist say over the next decade the state will go broke trying to pay them. Medicaid reform died in the legislative process last year, but with a newly elected Republican supermajority legislative leaders are more confident they’ll be able to make changes.

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