The federal government is more protective of the well-being of Florida's poor than Gov. Rick Scott and the Florida Legislature. Last year, over objections by Democrats and advocates for the poor, the Republican-controlled Legislature voted to turn the state's Medicaid program over to managed care companies. Never mind that persistent problems were experienced in a controversial five-county privatization pilot program and that any cost savings are uncertain at best. It was full steam ahead. That is until last week, when the federal government wisely stepped in to reject at least part of the statewide plan. This is a reminder that federal oversight is important in an era when states such as Florida are more interested in cutting spending than ensuring the poor have access to health care.
Two parts of the state's Medicaid reforms were jettisoned by the Centers for Medicare and Medicaid Services because they would have violated federal law and been excessively burdensome. The state will not be allowed to impose $10 monthly premiums, nor will it be able to charge $100 co-payments for any nonemergency ER visits, charges that were part of the state's attempt to rein in its more than $20 billion Medicaid budget. Imagine an indigent single mother worried about whether to bring her ailing child to the emergency room in case it turns out to be a nonemergency and she doesn't have the cash.
Federal regulators have yet to rule on whether Florida can hand over virtually the entire Medicaid program to private gatekeepers similar to health maintenance organizations. In a two-step process beginning in October 2013, the state wants to limit its Medicaid exposure by paying private companies a fixed price for a certain number of Medicaid beneficiaries, including the frail elderly in nursing homes. The companies would then have the right to approve what doctors patients could see and what procedures they could have done.
As a pilot program over the last five years in Broward, Duval and three rural counties, privatization has had its problems. While proponents point out that a small amount of money was saved, beneficiaries complained that they couldn't get doctors' appointments, and doctors dropped out after being second-guessed. Florida lawmakers pushed for a statewide expansion before it was known whether any money saved was due to efficiencies or because patients were poorly served.
Florida's zeal to cut costs without concern for outcomes is indicative of what would happen if Medicaid were turned into a state block grant program, as has been proposed by Republicans in Congress. It might be fine in states with more enlightened leadership, but it would harmful to the poor in states such as Florida where the bottom line is a bigger priority than providing health care for the poor. Strict federal oversight to ensure that Medicaid is a broad medical safety net is still essential.