There is no dispute that something needs to be done to rein in Medicaid, the health care program serving more than 2.9 million low-income Floridians at a cost of more than $20 billion. Whether the Legislature's head-first plunge into managed care is the best approach to try to reduce costs without compromising care is far less certain. The legislation the House is poised to approve today is too sweeping and too punitive, but there is plenty of time to make improvements.
Whether managed care will produce significant Medicaid savings without compromising care is questionable. The results from experiments in the Jacksonville area and in South Florida that began under Gov. Jeb Bush's administration have not been encouraging on either front. Yet lawmakers facing a $3.7 billion budget shortfall are desperate to save money, and their rush to limit Medicaid spending could harm low-income Floridians while producing negligible savings. As the House bills (HB 7107, 7109) are approved and separate legislation (SB 1972) advances in the Senate, here are five areas of concern:
Managed care regions. The state would be carved into regions, and health management organizations and provider networks would sign contracts in each region to treat Medicaid patients. The House would divide the state into eight regions, which seems to be too few and could require patients to travel too far. The Senate would divide the state into more than twice as many regions, and providers worry that some regions may be too small to attract bids. Lawmakers should strike a balance, but more regions would be better than too few.
Developmentally disabled patients. Medicaid serves more than 53,000 such patients, and most are adults with mental disabilities who live in their own homes. They often require specialized attention that managed care organizations may be ill-equipped to provide. The House includes them in managed care, but the Senate's approach to exclude the developmentally disabled from these changes is preferable.
Long-term care. The House and Senate would roll into managed care long-term care for old and disabled people. While these patients cost Medicaid more than $3 billion, there is considerable evidence that moving to managed care would be more expensive than the current fee-for-service program and result in other unintended consequences. These patients should be exempted.
Medically Needy. This program serves roughly 40,000 of the sickest of the sick whose income exceeds regular Medicaid limits. The Senate would cut prescription drug coverage and other services for all but pregnant women to save $230 million next year. That would deprive thousands of Floridians of the drugs they otherwise cannot afford, and it should be restored.
Lawsuit caps. There already is a $500,000 cap on noneconomic damages such as pain and suffering in medical malpractice cases that was adopted in 2003. Lawmakers would reduce that limit for Medicaid patients to $300,000 even though medical malpractice claims, payouts and malpractice premiums have declined since 2004. That would unfairly create two classes of Floridians and limit the ability of Medicaid patients to recover damages from providers who harm them.
Legislators have time to resolve these issues before agreeing on a final package. If they persist in such unfairness, the Obama administration has to approve a Medicaid waiver to allow Florida to make this wholesale change to managed care. There is a good chance Washington would be more sympathetic than Tallahassee to the concerns of low-income Floridians who rely on Medicaid for health care.