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Budget push for more privatization skirts full disclosure

Budget language that would ask the state to develop a plan to move those with developmental disabilities through a managed care system has drawn fire from some non-profits, who say it was inserted at the last minute without public discussion.

"We are concerned that managed care options may further cut services and reduce the ability of individuals with developmental disabilities to live in the community," stated a release by the Florida Developmental Disabilities Council. "Stakeholders for those with developmental disabilities were surprised that this language appeared during the last day of the (Health and Human Services/Healthcare) budget conference process and was quickly accepted."

The language in question was slipped into the legislative health care budget without discussion on Tuesday morning.

The new language would require the Agency for Health Care Administration and the Agency for Persons with Disabilities to develop a plan for serving Medicaid patients with developmental disabilities in a comprehensive managed care program. The program must be mandatory for all eligible recipients, competitively bid, and operated by comprehensive long-term care provider service networks for people with developmental disabilities.

"The proposed changes come in the form of language quietly added to legislation that would implement a managed care program across the state," said another statement by another group, The Arc of Florida, which advocates for local chapters, public policies and support for people with disabilities. "That would devastate families already struggling to care for loved ones with intellectual and developmental disabilities."

Debra Dowds, executive director of the Florida Developmental Disabilities Council, said managed care has higher administrative costs of up to 15 percent, while the the state's current Agency for Persons with Disabilities has administrative costs of only 4 percent. The higher overhead would take money away from those who need it the most, she said True, the language only calls for a study, but Dowds said that's a Trojan horse.

"Once you get a study like this, you pave the way for a system that will end up costing patients more," Dowds said.

The lobbying firm Ballard Partners helped convince lawmakers to add the language on behalf of Community LIfe Choices, a consortium of providers that would be eligible to provide care currently provided through the state's Agency for Persons with Disabilities.

Since managed care is the overall trend of the state, it's a prudent move to move Florida in that direction now, said Joe Aniello, president and CEO of the United Cerebral Palsy of South Florida, which is a part of the consortium.

Aniello said much of the outcry from some groups is "fear of the unknown." He said Tuesday's language merely asks lawmakers to study the costs so they could consider a managed care system for the developmentally disabled by next year.

He said administrative costs would be less than what Dowds claims and that the new system of managed care would actually save Florida money.

Jim Freyvogel, president and CEO of the MacDonald Training Center in Tampa, is also a member of the consortium. He said Florida's current Agency for Persons with Disabilities is no longer sustainable.

"There's insufficient funds and it's undermining care," said Freyvogel, who once worked for APD. "The idea is to get ahead of this issue."

But Freyvogel and Aniello acknowledged that the language emerged late in the budget negotiations.

Sen. Eleanor Sobel, D-Hollywood, sat on the committee and didn't hear anything about it.

"We keep shuffling these people around with an honest effort to save money, but we need to provide services, and that's the bottom line," Sobel said. "We should have had a discussion in committee about it, some sort of back and forth. It's new."

Florida House Speaker Will Weatherford and Senate President Don Gaetz have claimed they are intent on improving transparency, especially when it comes to the budget. Asked Friday about the late language, Weatherford said he didn't know about it, but would find out more.

Generally, however, he said he supports managed care.

"We're moving toward managed care as a state," Weatherford said. "But as for that specific proviso language, I haven't read it and I'm not familiar with it. I'll look into it."

Gaetz said it was a major issue that deserved more public scrutiny.

"The issue of moving developmental disabilities into managed care is a substantive issue and therefore it ought to be debated and discussed and vetted in a piece of legislation," he said.

A dueling email campaign has beseiged lawmakers, in the meantime.

"I am concerned that managed care options may further cut services and reduce the ability of individuals with developmental disabilities to live in the community," said Veronica Pappas of Jupiter in an email to Senate Appropriations Chair Joe Negron, R-Stuart. "It will do more harm than good."

"As parents of a son with autism, we would like you to stand firm on the budget proviso language that authorizes the (Affordable Care Act) to develop a plan for a managed care alternative," said Vicki Silver and Bob Banks in an email to Negron. "We believe this approach...will stabilize the existing system."