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Five-county Medicaid pilot program cleared to continue

MIAMI — Federal officials approved the expansion of a five-county Medicaid privatization pilot program Thursday that allows for-profit providers to determine the health care of recipients, but there's no indication whether a statewide expansion will be allowed.

Centers for Medicare and Medicaid Services spokesman Alper Ozinal said the agency was insisting on new protections, more accountability and quality reporting.

"We are separately considering the state's request to expand this demonstration statewide, and we are carefully weighing the input we've received from beneficiaries, providers, and other stakeholders," Ozinal said.

Florida needed federal approval of the five-county waiver in order to expand statewide.

Federal health officials have not signaled whether they will allow Florida to continue with an overhaul that would privatize the program statewide for nearly 3 million Medicaid recipients. Officials want to make sure the state addresses concerns about access to health care in the program raised by some residents.

A denial for statewide expansion could send state lawmakers scrambling for a solution to fix the $20 billion per year Medicaid costs they say are a strain on a tight state budget. About half of the funding comes from the federal government.

Florida's Medicaid battle has national significance as other states consider similar measures in lean budget times. Other states have components of managed care within the Medicaid program but experts say Florida's plan gives for-profit providers broad flexibility and power to dictate services and care.

The Republican-led Legislature passed two historic bills this past session privatizing the Medicaid program that cares for nearly 3 million poor and disabled residents, many of whom are children. Doctors have dropped out of the pilot program, complaining of red tape and that the insurers deny the tests and medicine they prescribe. Patients have complained they struggled to get doctor's appointments. Supporters of the overhaul say new accountability measures will address those concerns.

Several health plans also dropped out of the pilot program saying they couldn't make enough money.

Five-county Medicaid pilot program cleared to continue 12/15/11 [Last modified: Thursday, December 15, 2011 10:56pm]
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