If state legislators thought passing a fundamental change to the way Florida operates its Medicaid program was tough, at least they don't have to actually implement the changes.
State health care administrators Tuesday set out a schedule for public meetings designed to gain input from citizens on the switch, which moves patients from the fee-for-service health care delivery system, enshrined by the federal government in the 1960s when it created Medicaid, to a system akin to managed-care plans, where health care providers compete for contracts within certain regions in the state.
The administrators say they simply want to hear from citizens about their experiences in managed-care programs so they can smoothly switch to the new system. The Medicaid overhaul passed by lawmakers in the 2011 legislative session, and signed into law by Gov. Rick Scott last week, is based loosely on a pilot program in five Florida counties that went to a managed-care system from the traditional Medicaid delivery system.
Detractors -- mainly Democrats -- say the pilot program has resulted in worse outcomes for patients while not providing the promised cost savings. But proponents of the plan say the statewide Medicaid overhaul improves on the deficiencies of the pilot program, namely by ensuring that health management organizations or other providers are kicked out of the entire state if they unilaterally decide to leave one of Florida's 11 regions or fail to meet their health-care or cost-saving obligations.
During a meeting Tuesday of the Medical Care Advisory Committee, some doctors raised doubts about the cost savings contained in the law and whether first-year provisions to guarantee reductions in costs will push some physicians and providers away from the program or give them incentives to provide substandard care.
The Medicaid reform includes requirements for the standards of care in order to be eligible for the program, but also cost-saving reductions that lawmakers say will lead to $1.3 billion in savings in the first two years. Budget reductions and cost savings were one of the main reasons legislators targeted Medicaid for reform: It takes up nearly 30 percent of the state budget, more than half of which is funded by the federal government.
The remainder of health-care providers' profits exceeding 5 percent will revert back to state coffers, saving additional money in future years.
But some doctors are worried how that will work in practice, since it gives both the providers and the state a reason to book patients but scrimp on care.
"I know the state's not out there holding back, trying to withhold care, but you can see it's sort of a conundrum there," said Tallahassee physician Rich Thacker.
The public meetings will take place over the course of the next 10 days, and were hurried together in order to accommodate the required 30-day time period for collecting public input before administrators run into the deadline for getting a federal waiver, which is scheduled for Aug. 1. There will be 11 meetings, one in each health-care region of Florida, with the first being hosted at the Agency for Health Care Administration headquarters in Tallahassee on Friday.
Federal approval of the Medicaid changes in the form of a waiver from the Centers for Medicare and Medicaid Services (CMS) is required before the transition to a managed-care system can take effect. The actual move to a managed-care system won't start taking place until 2012, with the full transfer completed by Oct. 2014. Lawmakers and administrators remain hopeful of a waiver from federal authorities, even though state officials haven't submitted a formal waiver request for the statewide Medicaid changes. Instead, they're waiting to hear from CMS about an extension to the five-county pilot program, which must be given before the program expires on June 30.
"That has been the majority of our focus, and our understanding is that they (CMS) are proceeding in trying to authorize it before the expiration on June 30. With respect to the new waivers that we'll be seeking, I think it's too early to tell what their comments might be because we haven't submitted those yet," said Roberta Bradford, AHCA deputy secretary for Medicaid.
Reach Gray Rohrer at grohrer@sunshinestatenews.com or at (850) 727-0859 begin_of_the_skype_highlighting (850) 727-0859 end_of_the_skype_highlighting.
