Competing proposals for overhauling Florida's Medicaid program have two things in common. The House and Senate plans look to private managed care companies to try to rein in costs. They also ignore the advice of legislative analysts who are not sure if that strategy, already used in five counties, has saved the state money or improved patient care.
That's why the Legislature's rush to overhaul Medicaid in the waning weeks of this session is misguided at best and dangerous at worst. A decision affecting millions of Floridians — particularly those in nursing homes and the developmentally disabled — should not be decided in such haste and with such little analysis. Floridians would be better served if lawmakers settled on a less ambitious goal and spent another year considering their options. Federal stimulus money now and health care reform dollars later give the state time for more extensive deliberation.
About 2.8 million Floridians are on Medicaid, the federal-state program that provides health care for the poor and disabled. That number will grow under health care reform, but the federal government will pick up the entire additional cost for the first three years starting in 2014 and more than 90 percent of it after that.
Republican leaders say they need to plan for when the federal stimulus money fades and the reforms kick in. They seek to build on a 2006 project under Gov. Jeb Bush that shifted most Medicaid recipients in five counties from a fee-for-service model to HMOs or hospital-based provider networks. The providers receive a limited payment for each enrollee based on his or her general health.
But because individual patient information has yet to be fully analyzed, the state still doesn't know whether patients have received equal care under the experiment. The Legislature's Office of Program Policy Analysis and Government Accountability advised against expanding the experiment until more data was available. A University of Florida study suggests the experiment saved the state money in some cases but not in others, and it did not analyze the impact on patients' health.
Yet the Senate voted along party lines to expand the experiment to 19 other counties — including Hillsborough, Pinellas, Pasco, Hernando and Citrus — in 2010-11 to attempt to save $27 million. The House is considering a plan that would expand the program only to Miami-Dade next year. But in the long term, the House envisions moving all Medicaid recipients, including those in nursing homes and the developmentally disabled, to managed care contracts.
Either option is a radical expansion of a project with unproven results. Some of the state's most vulnerable residents would be thrown into the hands of private, for-profit companies whose first inclination far too often is to deny services to hold down costs. The projected savings in the first year in either plan — if they are to be believed at all — are nominal compared to Florida's $19 billion Medicaid budget.
The Legislature needs to address Medicaid costs. But it's more important to find the right solution than the politically expedient one. This is a rush job that could have devastating consequences.