Florida Legislature Nears Medicaid Overhaul Vote (FL)

January 30, 2010

DAVIE, Fla. — A crucial experiment in the future of Medicaid is playing out in Florida, where both houses of the Legislature are vying to find ways to drastically cut costs, manage care and reduce waste and fraud.

The cuts and changes being sought by the Republican-led Legislature and encouraged by the new Republican governor, Rick Scott, a wealthy former hospital company executive, are deeper than those in many other states and are intended to stanch the flood of Medicaid dollars.

In the past 11 years, the cost of Medicaid in Florida has grown from $9 billion to $21 billion, which amounts to a third of the state budget. The federal government pays more than half the tab.

“There is a consensus that the Medicaid system is irretrievably broken,” said State Sen. Joe Negron, a Republican who took the lead in writing th e Senate bill.

Based loosely on a five-year-old pilot program to shift care to HMOs, Florida lawmakers are now poised to scrap the traditional model in which the state pays doctors for each service they perform. Instead, almost all of Florida’s Medicaid recipients would be funneled into state-authorized, for-profit HMOs or networks run by hospitals or doctors.

HMOs or networks also would manage the long-term care of the elderly, shifting them away from nursing homes and expanding in-home care. Lawmakers who support the bill say the state needs this flexibility in curtailing the exploding cost of Medicaid in Florida.

The legislation in Florida is being closely watched by other states as they tackle the rapid growth of enrollment and the cost of care. With 3 million Medicaid patients and a high rate of uninsured people, Florida’s swift jump into managed care would be significant.

But there is concern across the state that the emerging proposals could not only reduce available health care for millions, but also leave the most vulnerable — the disabled, the elderly and those with serious chronic illness — at risk. An April study of the pilot program by Georgetown University raised doubts about patient services and cost efficiency, saying there was too little data.

“It can’t work,” said State Rep. Elaine Schwartz, a Democrat, who held town meetings on the program in Broward County, one of the five counties included in the pilot program. “It undermines the basic purpose of Medicaid, which is to provide services. If the private sector could have made money on Medicaid, they would have.”