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Florida watchdog agency urges no expansion of trial Medicaid program

TALLAHASSEE — The Florida Legislature's watchdog agency on Thursday recommended against expanding an experimental Medicaid program, once touted by former Gov. Jeb Bush as a national model, unless more data can be obtained.

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The Office of Program Policy Analysis and Government Accountability issued a final report saying little data is available to show the pilot program that uses private health management companies has improved access to medical care or its quality since its October 2006 launch. Such tracking information is not expected until January.

The agency also found a lack of data on whether any cost savings have resulted from the program, which began in Broward and Duval counties and expanded to Baker, Clay and Nassau counties. Bush obtained legislative and federal approval for the pilot as a response to rapidly rising Medicaid costs.

The report says another reason to hold off on adding the Panhandle and South Florida's Miami-Dade and Monroe counties to the experiment is that it would cost the state an additional $7.1 million the next budget year. It also cited questions raised by patients, doctors and other stakeholders, and "symptoms of plan instability."

Agency for Health Care Administration Secretary Holly Benson, in a response published with the report, took issue with the some of agency's comments — but not its recommendation to hold off on expansion.

Benson's agency administers Medicaid in Florida. The state-federal program for the poor and elderly typically lets patients see their own doctors, who then are reimbursed.

Under the pilot, though, the program pays private companies a set amount for handling a certain number of patients. The companies then decide how to care for the patients, including which doctors they can see.

WellCare, the largest provider, withdrew from the pilot. Other providers reduced the number of plans patients can select, and some have stopped enrolling new participants in the pilot counties.

Benson argued those changes are not a sign of instability but a "normal business process."

She also questioned the agency's interest in cost savings because a federal waiver for the pilot requires only that it be "budget neutral" — costing no more than the regular program.

The report shows the pilot cost nearly $35.6 million from July 2006 through December 2008, including development expenses. Data are not yet available to determine if the pilot has resulted in "cost savings or is more cost-effective than traditional Medicaid," the report said.

Benson also takes issue with the report's interpretation of a University of Florida study by concluding Broward and Duval patients' overall satisfaction with their health care "significantly decreased" under the pilot.

She wrote that "some negative shift in satisfaction is to be expected" and that "such few significant differences … may actually indicate a more positive satisfaction than would have been anticipated."

Florida watchdog agency urges no expansion of trial Medicaid program 06/18/09 [Last modified: Sunday, June 21, 2009 9:25am]

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