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Signs of success don't ensure Medicaid reform's survival

Costs are down. Patients appear satisfied. Doctors are practicing more preventive care.

Despite these encouraging signs, former Gov. Jeb Bush's "Medicaid Reform'' experiment looks like it won't expand statewide beyond Broward County and four Jacksonville-area counties as he had hoped.

The HMO industry doesn't like parts of the plan. Liberals say the program hasn't been properly studied. And Republican legislators are concentrating on solutions of their own to control growing costs of the program.

But not all the ideas behind Medicaid Reform — such as expanding managed care, providing hospitals more money or trying to provide more patient choice — are dead.

On Wednesday, the state's reform expert, University of Florida researcher R. Paul Duncan, is scheduled to brief the Senate's Health Regulation Committee to help legislators assess the program as they conduct a top-to-bottom review of Medicaid and the Bush reform.

"Medicaid Reform is not the panacea that will solve all of Medicaid's problems," Duncan told the Times/Herald. "But it's also not the train wreck that opponents had envisioned and feared."

Duncan, director of the Florida Center for Medicaid and the Uninsured, has studied the reform plan since Bush pushed it through a reluctant Legislature in 2005. Bush wanted the reform statewide, but the Senate scaled it back to five test counties.

Under federal rules, the program expires in summer 2011. Due to Medicaid's complexities, experts say the Legislature needs to decide this session whether it wants to keep the reform going.

Medicaid is a state-federal program, whose rolls grow as unemployment rises. It now provides health services to 15 percent of Florida's population and consumes more than a quarter of the state budget. Seeing the troubles the state might face, Bush proposed reforms that:

• Require Medicaid recipients to enroll in a managed-care plan — but not necessarily an HMO. Bush envisioned that doctor and community groups would establish their own managed-care companies. A so-called choice counselor helps patients decide what plan is best for them.

• Change the way managed-care companies are paid. Rather than get an across-the-board fee for large groups of patients, the companies get a "risk-adjusted premium'' giving them more money to handle sick patients and less money to manage healthy ones.

• Divert a portion of each patient premium into a special "enhanced benefit'' fund that patients could access to buy health supplies — such as diapers or Band-Aids — if they demonstrated healthy choices, such as getting all their doctor checkups.

• Allow managed-care companies more power to decide benefits.

Duncan said he's not done studying the program.

So far, he said, patient-survey data shows that there's no difference in patient satisfaction between reform and non-reform counties. But costs are lower in reform counties.

The state's Agency for Health Care Administration reports that more patients are getting lead screenings and access to preventive care in reform counties, among other benchmarks.

But that might not enough for Sen. Don Gaetz, the Niceville Republican who heads the Senate's health regulation committee.

"Five years ago, we could care about costs and health outcomes and reforming the program," Gaetz said. "Now we're really worried about costs."

Liberal groups like Florida CHAIN, a Medicaid patient advocacy group, say the surveys showing successes in the reform program don't have enough data and are misleading. The Broward-based group argues that patient satisfaction is low and the program hasn't lived up to its billing.

Republican legislative leaders are examining whether to turn more of the Medicaid program over to traditional HMOs or whether to institute a doctor-based managed-care system. Gov. Charlie Crist has been silent on the debate.

The man who wrote the Medicaid Reform plan, Alan Levine, said the program faces an uncertain future because no one is championing Bush's legacy in the Capitol.

"It's about leadership. There isn't any," said Levine, now Louisiana's hospital agency director. "I could understand if outcomes were poor and if Medicaid weren't getting bigger. But that's not the case."

Marc Caputo can be reached at

Signs of success don't ensure Medicaid reform's survival 02/02/10 [Last modified: Tuesday, February 2, 2010 9:31pm]
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