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Top Story

Senator’s bill would exempt disabled from Medicaid Reform

By Christine Jordan Sexton
3/20/2008 © Florida Health News

TALLAHASSEE---The GOP-controlled Legislature continues to be divided over the future of Florida’s Medicaid program, setting the stage for a confrontation over the next few weeks. While the House of Representatives aims to expand Florida’s experiment with Medicaid managed care, a state Senate panel on Wednesday approved a bill that would exempt from the reform experiment for at least one year developmentally disabled people as well as children with persistent mental illness.

 In addition to removing some of the most vulnerable and medically complex populations from the pilot program, SB 1570 would prevent expansion of the Medicaid pilot program into additional counties until improvements were made.

The committee’s decision to advance the bill puts the Senate directly at odds with the leadership of the House, which wants to roll out the reform program into additional counties, despite a spate of critical studies. House Healthcare Council Chairman Rep. Aaron Bean acknowledged on Wednesday  there is “a lot of opposition” to expanding the current program into Miami Dade County but repeated his message that the pilot program will be reformed and improved.

Bean, a Republican from Fernandina Beach, refused to say when he would unveil his “modified reform plan” other than to say soon.

“I think if we do that we'll get a more favorable reception,” said Bean, who added “I'm not ruling out other counties (for expansion) as well.”

 

Sen. Lynn
The bill’s sponsor, Sen. Evelyn J. Lynn, represents parts of Clay County, one of the counties near Jacksonville that were included in the Medicaid reform program.  She told members of the committee about a mother in her district who had to have her son involuntarily committed after his Medicaid reform health plan switched his medication.
 
Lynn said the mother was told that the boy was locked into his Medicaid reform plan and couldn’t switch for one year. Lynn said she contacted AHCA three times during the year to have the issue resolved. “That’s unacceptable,” she said.
 
Florida’s Medicaid reform plan was designed by former Gov. Jeb Bush and former AHCA Secretary Alan Levine, who said they could stretch Medicaid dollars further and provide better access to specialists if patients were in managed-care plans.  Lynn said the specialty networks and improved care that Bush and Levine promised have not sprouted up. Instead, she said, people with medically complex needs are being enrolled into traditional managed care plans.
 
 “In many cases, there’s not adequate services available for these very severe cases,” Lynn said. “You cannot just leave people in these situations hanging. People with severe problems need to have constant and immediate care.”
 
Lynn’s bill would require specialty service delivery systems be developed within the Medicaid reform pilot for persons who meet nursing home level of care requirements as well as for people with severe and persistent mental illness. The bill also would:
 
  •  Require  AHCA to establish a formal appeals system to address disputes between managed care plans and treatment providers.
  •  Require AHCA to start collecting information about incidents in which patients are unable to get their prescriptions filled, to determine whether the denial occurred because the drug was not on a formulary – the list of drugs the plan covers -- or because the patient had hit the spending limit.
 The bill cleared the Senate Health Policy unanimously but must be heard in three more committees, including a spending panel,  before making it to the Senate floor.
 
The Agency for Health Care Administration estimated that it would take nearly $8 million over a two year period to implement the changes required by the bill.
 
Christine Jordan Sexton, Tallahassee correspondent, can be reached at cjordansexton@hotmail.com.