Make us your home page

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

Florida's Medicaid program heading to managed care system

As Washington grapples with debt ceilings and spending, another set of fiscal negotiations quietly begins this week that will impact Floridians for years.

The Legislature voted in May to turn the state's entire Medicaid program over to private managed care. But because the federal government shoulders most of the bills, the Obama administration must give its assent.

At stake are billions of tax dollars and the health of more than 3 million poor and elderly Floridians. The debate around the issue already is dividing along philosophical and political lines.

Democratic legislators wrote a letter this month urging federal officials to veto the program.

Florida already tested managed care — in a five-county pilot project that "has been plagued with problems,'' the Democrats said.

"Now, the legislation calls for expansion of Medicaid managed care plans to all 67 counties … while giving those plans unprecedented flexibility to vary the amount, duration and scope of benefits in confusing and risky ways.''

State Sen. Joe Negron, R-Palm City, countered that managed care is a nationwide trend that can control costs and improve services.

"What Florida is asking for is well within the mainstream,'' said Negron, who spearheaded the legislation. "Hopefully, the current administration will give Florida the flexibility to manage a Medicaid program we can all be proud of.''

But if Washington throws up too many roadblocks, he said, "the federal government commandeering a state budget will be a national political issue.''

Florida's Agency for Health Care Administration is scheduled to submit details of the plan today to the federal Centers for Medicare and Medicaid Services, which will evaluate it, make tweaks and possibly demand revisions. Such negotiations can easily take six months to a year.

By the Legislature's timetable — which Washington need not heed — the state would begin negotiating contracts with managed care companies next July, with actual care starting in 2013.

The new system would divide the state into 11 regions, with as few as two managed care plans in the rural Panhandle and as many 10 in populous South Florida.

Clients would select a plan or be assigned one. Plans would collect a per-client stipend from the state and provide all care through a network of doctors, hospitals and other services.

Plans, often run by insurance companies, could make a profit if they treat clients for less cost. Not-for-profit networks of hospitals, nursing homes and other care providers could also set up their own managed companies.

Critics worry that managed care companies will make money off the backs of the poor by simply skimping on services.

Payment rates already are so chintzy that Medicaid patients struggle to find doctors, said Dr. Mathis Becker, president of the Hillsborough County Medical Association, which opposed the plan with 100 other groups in a recent letter.

"The planned reform is not going to solve this issue and indeed may intensify it,'' Becker said, "because it will empower those Medicaid managed care companies to put on pressure to negotiate for even lower fees for physicians.''

Such fears are not supported by reality, said Michael Garner, president of the Florida Association of Health Plans. Isolated, anecdotal problems have cropped up in pilot managed care programs, he said, but surveys show high levels of patient satisfaction.

There is little evidence to indicate they have not received all medically necessary care, he said. Plus, the new system builds in protections, he said, such as depriving plans of new clients if quality standards aren't met.

A managed care company makes money by keeping clients healthy, Garner said. Skimping on prenatal care for a pregnant woman can lead to expensive, complicated deliveries. Letting a urinary tract infection go unnoticed in a nursing home can lead to expensive hospitalization.

"It's going to drive up our costs if the health outcomes drop,'' Garner said, "and we can get kicked out of the program.''

One of the legislation's most ambitious undertakings is long-term care for disabled and frail old people. Since nursing home bills devastate family finances, Medicaid takes on middle-class clients as well as the poor.

Managed care companies will try to serve most people in assisted living or in their homes, bringing in aides and medical equipment — anything to keep people out of nursing homes.

But in a decade-old pilot program to deliver home-based services — known as Nursing Home Diversion — managed care turned out to be way more expensive than comparable fee-for-service programs run by nonprofit agencies. In some cases, managed care companies spent only 70 to 80 percent of their stipends on patient care, keeping the rest for overhead and profit.

Early versions of the managed care bill capped profits, but not the final version, one reason AARP opposes the proposal.

Profits or no, the new system mandates managed care save the state money, and that's the bottom line, Negron said.

Medicaid costs $22 billion a year and is growing twice as fast as the state budget, "which crowds out education, development and other priorities,'' he said. "Medicaid can no longer have a blank check.''

Florida's Medicaid program heading to managed care system 07/31/11 [Last modified: Sunday, July 31, 2011 9:48pm]
Photo reprints | Article reprints

© 2017 Tampa Bay Times


Join the discussion: Click to view comments, add yours

  1. Astros rout Yankees to force Game 7 of AL Championship Series


    HOUSTON — Justin Verlander pitched seven shutout innings to outduel Luis Severino for the second time, and the Astros bats came alive in their return home as Houston routed the Yankees 7-1 Friday night and forced a decisive Game 7 in the American League Championship Series.

    The Astros’ Brian McCann, who has struggled during the ALCS, breaks a scoreless tie with an RBI double during the fifth inning off Yankees starter Luis Severino.
  2. Review: Faith Hill and Tim McGraw shower love, star power on Tampa's Amalie Arena


    Near the end of their potent new duet Break First, Tim McGraw stopped singing, and let Faith Hill's powerhouse voice take over.

    Faith Hill and Tim McGraw performed at Amalie Arena in Tampa on Oct. 20, 2017.
  3. Senate to take up AUMF debate as Trump defends reaction to Niger attack


    WASHINGTON — The Senate Foreign Relations Committee is taking up a long-awaited debate about authorizing military force against the Islamic State as President Trump comes under unprecedented public scrutiny for his treatment of dead soldiers' families, following an ambush on troops helping to fight Islamic …

  4. In fear and vigilance, a Tampa neighborhood holds its breath


    TAMPA — There was a time, not long ago, when Wayne Capaz would go for a stroll at night and Christina Rodriguez would shop whenever she wanted. Michael Fuller would go to his night job as a line cook, not too worried about his wife at home.

    More than 50 people gathered and walked in the Southeast Seminole Heights community Friday to pay respects to the victims of three shootings. The crowd took a moment of silence at the corner of 11th Street and East New Orleans where Monica Hoffa was found dead. [JONATHAN CAPRIEL  |  Times]
  5. Fennelly: What's not to like about Lightning's start?

    Lightning Strikes

    BRANDON — No one is engraving the Stanley Cup. No one has begun stuffing the league MVP ballot box for Nikita Kucherov.

    The Lightning, with a win tonight, would match the best start in franchise history, 7-1-1 in the 2003-04 Cup season.