House health budget calls for expanding Medicaid reform

By Christine Jordan Sexton
03/2

Bean

8/08 © Florida Health News
TALLAHASSEE—-Ten additional counties—including heavily populated Miami-Dade-- would be included in Florida’s Medicaid reform initiative under a proposal released by House leaders on Thursday. The expansion is included in the $1 billion-plus cuts in health care spending proposed by House Healthcare Council Chairman Rep. Aaron Bean, R-Fernandina Beach.

Bean wants to expand Florida’s Medicaid reform plan into Miami-Dade and Monroe counties beginning July 2009. Tampa, St. Petersburg, Bradenton, Lakeland and some smaller rural counties would be included in the pilot reform beginning July 2010.

Sen. Durell Peaden, R-Crestview, who chairs the Senate health care spending panel, said his chamber has no interest in expanding the Medicaid reform plan beyond Broward, Duval, Baker, Clay, Nassau and Putnam counties until a study being conducted by the University of Florida is completed this summer.

Neither the House nor the Senate has finalized their spending proposals; that will occur next week. However, if the chambers continue to have different positions on expanding the Medicaid reform project, the issue will be decided in “conference” where a handful of lawmakers negotiate the differences between the proposals. If the conferees can’t bridge the differences, the issues will be “bumped up” to House and Senate leadership to resolve.

Bean has said for weeks that he will “reform Medicaid reform.” The proposal released on Thursday is only an outline and contains very little details.

For instance, Bean’s document shows that he wants to “improve state oversight and quality” of Medicaid managed care reform plans by requiring the state Agency for Health Care Administration to “regularly” monitor and evaluate Medicaid reform plans for network adequacy. It does not provide details of how often the plans be monitored.

Additionally, Bean’s proposal shows that he wants the agency to set standards to require Medicaid managed care reform plans to promptly pay providers but the proposal doesn’t provide information on how long plans would have to reimburse the providers.

Bean also wants to ensure that Medicaid beneficiaries receive “accurate and current prescription drug coverage information for each (reform) plan.”

The Medicaid reform pilot project has been bedeviled by problems since it took effect in 2006. The managed care pilot project requires virtually all Medicaid beneficiaries who aren’t in institutions to enroll in an HMO or other managed-care network. If they don’t choose one for themselves, they’re automatically assigned to one. Like commercial insurance plans, Medicaid reform plans are allowed to restrict benefits.

Florida Legal Services filed a class action law suit after patients enrolled in the Medicaid reform plan complained they were not receiving services. An AHCA Inspector General report also noted a series of problems with the Medicaid experiment.

While the billion in budget cuts and Medicaid reform expansion was unveiled in the House Healthcare Council, members of that committee won’t have the opportunity to vote on those ideas. Instead, the Policy and Budget Council, chaired by Rep. Ray Sansom, R-Fort Walton Beach, will finalize the spending reduction plan —as well as the five implementing bills that will make the statutory changes needed to implement the spending policy. Medicaid reform expansion will be included in one of the implementing bills.

Rep. Loranne Ausley, D-Tallahassee, is the ranking Democratic member of the Healthcare Council and also serves on the Budget and Policy Council. As such, she will have the opportunity to continue to influence the health care spending proposal. But at a House Democratic press conference, Ausley expressed concerns that many members from the Healthcare Council won’t have continued input.

Ausley noted that the implementing bills will contain “more policy than the last five years” of health bills passed by the Legislature.

Christine Jordan Sexton, Tallahassee correspondent, can be reached at cjordansexton@hotmail.com.