FORT LAUDERDALE — Republican lawmakers' quest to expand a Medicaid privatization program statewide was dealt a blow this week after federal health officials said the state could not impose $10 monthly premiums on Medicaid beneficiaries.
The Centers for Medicare and Medicaid Services also denied the state's proposal to charge $100 co-pays for any non-emergency ER visits, according to a letter sent Thursday. Federal health officials said the fees violated several statutes designed to protect nearly 3 million of state's most vulnerable.
Lawmakers passed the bills last year trying to rein in the Medicaid budget of more than $20 billion a year and increase accountability for providers. Under the plan, the government pays private companies a set amount for handling a specific number of residents — similar to a health maintenance organization, or HMO, in the private sector. The companies, in turn, decide how to care for the patients, including which doctors they can see and what treatments can be prescribed.
The privatization program builds on a controversial five-county pilot program that started in 2006. Patients said they struggled to get doctor's appointments and doctors dropped out of the program complaining the health plans denied the treatments they prescribed. Several health care providers also dropped out of the program, saying they couldn't turn a profit, leaving patients to be deal with gaps in services as they were bounced between plans.
There has also been little data evaluating the program. The state has not tracked what services were denied and it's unclear whether the small amount of savings was because patients got less care or because it was delivered more efficiently.
Several outspoken Democratic lawmakers, including Rep. Elaine Schwartz, have hammered the importance of such data, worrying the for-profit health providers will line their pockets with administrative costs unless closely monitored. Federal health officials have insisted the state require private health plans to spend 85 percent of funds on patient care.
"We hope this is just the start of gutting this bad program, and not a mere sop to those of us who see Florida's proposal as a true gutting of the purposes of Medicaid," Schwartz said.
Federal health officials applauded the state's desire to cut down on unnecessary emergency room visits and said they would work with the state on other alternatives to meet that goal, according to the letter.
Officials at Florida's Agency for Health Care Administration said they were disappointed with the CMS decisions, but said they would continue to work with the federal agency on other key elements and they are confident statewide expansion can move forward.
Supporters said the legislation fixed problems in the pilot program by adding increased oversight for providers and more stringent penalties, including fining providers up to $500,000 if they drop out. The measures also increase doctors' reimbursement rates and limits malpractice lawsuits for Medicaid patients in hopes of increasing doctor participation in the program.
The bills require providers to generate a 5 percent savings the first year, which could save the state about $1 billion.
"Florida is still recovering from a challenging economy. Washington is broke. I remain hopeful that the Obama administration will work with us as equal partners in Medicaid and respect the Legislature's right to control our state budget," said Republican Sen. Joe Negron, who spearheaded the health overhaul.
Democrats in both the House and Senate voted against the state's Medicaid overhaul last year and health care advocates have since sent a stream of letters from unhappy patients to federal health officials, urging them to reject a statewide expansion.