TALLAHASSEE — A House health-care committee on Monday began debating a proposal to overhaul Medicaid, amid questions about how to carve up the state geographically into a managed-care system.
The House proposal would split the state into seven regions where health maintenance organizations and other types of managed-care plans would compete to win Medicaid contracts.
But some lawmakers and interest groups raised repeated questions about whether that road map would work, particularly in rural parts of the state.
For example, Rep. Janet Cruz, D-Tampa, said one proposed region would stretch from Pensacola to Madison County in north-central Florida — raising the possibility that patients might have to travel hundreds of miles to see a specialist.
Conversely, Rep. Mia Jones, D-Jacksonville, said Broward and Miami-Dade counties would be placed in different managed-care regions.
She said that could affect patients who might travel across the county line to see doctors or other providers.
But House Health and Human Services Chairman Robert Schenck, R-Spring Hill, said each region needs enough population to make the system financially viable for health plans.
He acknowledged that will require some changes, such as in where patients are referred for care.
As an incentive to try to get managed-care plans to compete in rural areas, the bill includes a sweetener:
If plans do business in the Panhandle, they also will get contracts for heavily populated Miami-Dade and Monroe counties.
"Certainly, the Panhandle is the most-challenging aspect of this, because of the rural nature of it,'' Schenck said.
Carving up the state is a fundamental issue as House and Senate lawmakers move forward this spring with a Medicaid overhaul that would place almost all beneficiaries into managed-care plans.
The Senate has proposed another geographical approach, slicing the state into 19 smaller regions.
House and Senate leaders have vowed to pass a Medicaid overhaul, as they try to rein in the cost of the $20 billion health-care system.
The chambers have released widely differing proposals and will have to negotiate a compromise in the coming weeks.
The House Health and Human Services Committee on Monday spent about two hours discussing its proposal and taking testimony.
The committee is scheduled to vote on the proposal, which is spread over two bills, on Thursday.