Florida House Dems Want Feds to Reject Medicaid Waiver

A delegation of Florida House members sent a letter Friday to the Center for Medicare & Medicaid Services (CMS), asking the federal agency to reject a waiver sought by the state to change its Medicaid program from a fee-for-service system to a managed-care system.

Republicans passed the Medicaid reform package earlier this year and Gov. Scott signed it into law. It requires federal approval and the Medicaid program is scheduled to begin transitioning into a managed-care program in 2013, and to be completed statewide by 2014. The deadline for the state to submit its waiver request to CMS is Aug. 1.

Florida Democrats largely decried the move to reform Medicaid, but could not do much about it, being vastly outnumbered in the Legislature. In the letter, they also ask the feds to reject another waiver for a five-county pilot project that is similar to the statewide proposal. The pilot program began in 2006 and recently received a month-long waiver from CMS that ends July 31.

Here is the text of the letter in full:

Dear (Deputy CMS) Director (Cynthia) Mann:

We write to express strong opposition to the forthcoming application CMS is expected to receive from the Florida Agency for Health Care Administration (AHCA) seeking a new or significantly modified Section 1115 Medicaid Research and Demonstration Waiver.

The Florida Legislatures passage of House Bills 7107 and 7109 calling for the implementation of a new statewide experiment in Medicaid managed care requires AHCA to submit its waiver proposal to CMS by August 1, 2011. In addition, the State of Florida has requested CMS renew the 2006 waiver in the five pilot counties, which should be denied.

As Democratic ranking members on health care committees in the Florida House of Representatives, we have expressed serious concerns on the record with the statewide proposal in our respective committee and during extended floor debate in the Florida House of Representatives. We also bring to your attention the fact that every Democratic member in both chambers of the Florida Legislature voted against final passage of the legislation.

Specifically, we ask that CMS reject the states request for approval of the proposed statewide Medicaid managed care experiment for the following reasons:

The track record of Medicaid managed care and Medicaid HMOs in Florida is cause for very serious concern. This is particularly the case with the States current Medicaid Reform Pilot Program and Section 1115 waiver that authorizes it, which provides the foundation for the statewide managed care expansion authorized under the new legislation.

The current Medicaid Reform experiment has been plagued with problems over its five-year history. Now, the legislation calls for expansion of Medicaid managed care plans to all 67 counties and almost all groups of recipients by 2014. The experiment would require enrollment in capitated managed care plans, while giving those plans unprecedented flexibility to vary the amount, duration and scope of benefits in confusing and risky ways.

The new legislation builds on a failed managed care platform, expands its scope, introduces additional experimental elements and dramatically accelerates its implementation, but without resolving the outstanding problems and concerns of the current pilot.

Among our concerns, we have doubts about AHCAs capacity to generate and analyze a complete set of validated patient encounter data in order to assess the effect of this Medicaid managed care experimentation on access to, quality of and cost-effectiveness of care. And although the legislation calls for plans that fail to meet standards to be penalized, it fails to include measures to protect recipients in the event that those standards are not met.

The legislation also abandons some important goals of the five-county pilot that have not been realized (e.g., patient education and empowerment), which seems to make the proposal less patient-centered while giving more latitude to capitated managed care plans.

Additionally, the legislation calls for a number of new elements that are not part of the five-county pilot that may imperil many vulnerable Floridians. These include, but are not limited to, such things as imposing exorbitant premium requirements on Medically Needy recipients with catastrophic medical needs, up to thousands of dollars per month.

In conclusion, we urge you to reject the states forthcoming application for a new or modified Section 1115 Waiver that would expand or accelerate an untenably risky experiment to include millions of new and even more vulnerable patients. In addition, we feel that the 2006 waiver in the five pilot counties should expire this month.

Thank you in advance for your consideration of this important request.

Sincerely,

Mia L. Jones, Representative, Florida House District 14

House Health & Human Services Committee, Democratic Ranking Member

Mark S. Pafford, Representative, Florida House District 88
House Health Care Appropriations Subcommittee, Democratic Ranking Member

Steve M. Perman, Representative, Florida House District 78

House Health & Human Services Access Subcommittee, Democratic Ranking Member

Elaine J. Schwartz, Representative, Florida House District 99
House Health & Human Services Quality Subcommittee, Democratic Ranking Member