A transformational reform of Medicaid in Florida encountered skeptical patients Friday during the first of 11 public meetings throughout the state. But some stood up for the new law, noting there are sufficient provisions in the reforms to ensure high-quality care in addition to cost savings.
Gov. Rick Scott signed a comprehensive change in the state's Medicaid system passed by legislators last month, which transitions Florida's 3 million Medicaid recipients into managed-care or similar health-care plans. The switch won't begin until July 2012, and won't be complete until October 2013, but requires a federal approval in the form of a waiver in order to be properly implemented.
State administrators from the Agency for Health Care Administration must conduct public meetings throughout the state 60 days before the waiver deadline of Aug. 1. Ten more meetings are planned throughout the state next week, but officials at the first meeting in Tallahassee Friday met with patients and providers who cast doubt on the promised cost savings and the maintenance of high-quality care standards.
"HMOs are in business to make money. I do not see how anyone can make money on my son's condition. I am not making any money on my son's condition," said Martha Moore, a Gadsden County resident whose son is a quadriplegic.
As part of the transition, health management organizations and provider service networks will compete for contracts with the state in 11 different regions. Lawmakers and advocates of Medicaid reform say that provisions requiring a minimum level of care, in addition to cost reductions, will ensure that Medicaid patients --the largest item in Florida's budget --retain the level of care to which they are accustomed.
"The plans that are selected are driven by quality," said Michael Garner, president and CEO of the Florida Association of Health Plans.
Florida's Medicaid program is financed at $22 billion this year, taking up nearly 30 percent of the budget, up from 18 percent at the beginning of the previous decade. Republican legislators, laboring under a $3.8 billion budget shortfall, said the rising costs of the program were elbowing out needed dollars for education and other priorities.
But the move to managed care is leaving some unconvinced of the power of the private sector to hold costs down while maintaining care. The tried and tested status quo of fee-for-service, which critics say is a boon for fraudulent activity, is preferred for some.
Laura Cantwell, a representative of the Association for the Advancement of Retired Persons, favored locally centered, patient-oriented, fee-for-use programs.
"These bottom up rather than top down approaches would produce better outcomes," she said.
Small-business pharmacists also expressed concern over the law's provisions which promote mail-order drug delivery, and those they say don't include enough protections for patients to be able to get medicine from a pharmacy that is not in the network. Those in favor of the law, however, said it allows patients greater choices, not less.
"There is nothing in this law that says there is only one way that medication will be received," Garner said.
Other speakers worried that precious state time and money was being used to implement a system that might not get federal approval. Paul Belcher of the Florida Hospital Association urged AHCA officials to measure the new Medicaid reforms against an April letter from the Center for Medicaid Services, the federal agency tasked with reviewing Florida's waiver, that outlines which provisions it is likely to accept. The bidding process for contracts within each region should be open and fair, he added.
"We believe there is a need for additional accountability and transparency," Belcher said.
Reach Gray Rohrer at grohrer@sunshinestatenews.com or at (850) 727-0859.
