Taking up Senate President Mike Haridopolos call to make Medicaid reform within Florida a priority, Senate leaders held a freewheeling discussion Wednesday with health care providers, insurers and patients in the first step toward comprehensive legislation.
A day after new legislators were sworn in, Sen. Joe Negron, R-Port St. Lucie, whom Haridopolos has tapped as Health and Human Services Appropriation Subcommittee chairman, decried the way Medicaid is currently run.
For me, the main takeaway is that the Medicaid system is broken, Negron said.
The Legislature passed a nonbinding memorial Tuesday urging the U.S. Congress to give the state more flexibility in running its Medicaid program, and announcing its intent to reform the system. The measure was passed by a voice vote in both chambers, but there was lengthy debate in the Senate over the bill, with some Democrats voicing opposition.
Legislators are concerned that rising numbers of eligible Medicaid recipients will lead to the program taking up 33 percent of the state budget by 2014, and are determined to grapple with the issue in the next regular legislative session.
In his questions and comments to speakers during the discussion, Negron seemed to favor an integrated managed-care approach, one that would use a contract compliance mode of paying for health care services, instead of the fee for services, or pay and chase method currently used.
We need to get out of the check-writing business and into the contract compliance business, Negron said.
Negron mentioned that a performance bond contingent on savings benchmarks, as Arizona has done, would be one way to ensure that Medicaid participants provide quality care and are financially responsible.
Alan Levine, president of Health Management Associates, a company that manages hospitals, agreed that the pay and chase approach is susceptible to fraud.
Fee for service -- thats good for providers, but thats also good for the crooks, Levine said.
Negron insisted that nothing has been settled in regard to any managed-care reforms, but was nonetheless adamant that some type of reform is needed sooner rather than later.
We need to have medical care to be coordinated. How its going to look, thats to be determined, Negron said.
While some physicians and Medicaid recipients were amenable to a managed-care system, they were wary of any new Medicaid changes that would push patients into HMOs, where they believe care would come as a second priority to the bottom line.
Dr. Madelyn Butler, president of the Florida Medical Association, urged senators to make any managed-care system fair for all stakeholders.
If you do decide to expand managed care, we hope that ... you do it on a level playing field, Dr. Butler said, adding that Florida still needs to grab fee-for-service dollars from Medicaid.
But for any reform legislation to work, a sufficient amount of doctors and providers must sign on, and in order to attract them, Medicaid payments must be efficient and provide enough of an incentive to entice doctors.
The only way that you are going to increase the level of physician participants in Medicaid is to increase the level of reimbursements, Dr. Butler said.
While most speakers agreed that Medicaid as it is currently run is not sustainable and needs to be changed, some who work with developmentally disabled patients expressed concern that any reductions in funding to the program would fall on their patients.
Senators said they wanted to move very cautiously in regard to those programs, insisting that any changes would not fall disproportionately on the most vulnerable patients.
I dont think theres anything inevitable about this, said Sen. Don Gaetz, R-Destin.
But Gaetz did admit that legislators cannot enact overwhelming reform of Medicaid without upsetting some people.
The first people were going to upset are the ones who are overspending and over-utilizing the system, he said.
Legislators will conduct committee meetings on Medicaid reform next month.
Reach Gray Rohrer at grohrer@sunshinestatenews.com or (850) 727-0859.
