Medicaid Reform opponents kill Miami-Dade expansion

 By Christine Jordan Sexton
4/4/2008 © Florida Health News

TALLAHASSEE- Florida lawmakers have scuttled an effort to expand the state’s controversial Medicaid reform pilot program for now. The program is already running in Broward and in Northeast Florida and House Republicans wanted to expand it into Monroe and Miami-Dade counties. But the House Policy and Budget Council on Thursday voted to delay the expansion into South Florida, as well as Pasco, Pinellas, Hardee, Hillsborough and Manatee and Polk counties, until 2010.  

The Senate has not supported the expansion.

The push to delay the expansion into South Florida came from Miami-Dade County delegation chairman Rep. Juan Zapata, R-Miami, who quietly thanked council membersfor postponing the expansion of the plan into his county.

By delaying enrollment in the plan until September 1, 2010, Zapata said, the Legislature will have “the next two legislative sessions” to examine the results of a University of Florida study and to “address the issues.”

Top House Republicans, however, contend it is inevitable that the state will expand the pilot program even though it has come under fire from health care advocates and been the subject of a critical inspector general’s report. Rep. Aaron Bean, R-Fernandina Beach and chairman of the House Healthcare Council, called the current Medicaid program “truly unsustainable’’ due to its costs.

“We believe the program is working,’’ said Bean. “We are going to ask for input and as we go forward we think we can make some tweaks to reform and if we don’t do Medicaid reform we are left with very few options.”

Before the Agency for Health Care Administration—which administers the Medicaid program—can expand the initiative beyond the existing counties, it must first get permission from the Legislature. In addition to delaying the expansion into Miami Dade County, Zapata’s amendment deleted language that would have allowed statewide expansion effective 2011.

The Medicaid reform pilot was launched in Broward and Duval counties in 2006 and later expanded to Baker, Clay, and Nassau, the more rural areas just outside metropolitan Jacksonville.

The initiative aims to make Medicaid more closely resemble private health insurance, where costs are predictable because the benefits can be capped. It 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.

Florida’s Medicaid reform project obtained a waiver of certain federal rules for the program from the Centers for Medicare and Medicaid Services, which provides more than half of the funds for the health insurance program for poor women and children and the low-income elderly and disabled. The so-called Medicaid 1115 demonstration project waiver is good for five years, and expires June 30, 2011, or ten months after the state expands the reform plan.

When Florida submitted its waiver application to CMS on Aug. 30, 2005, AHCA predicted that the reform program would be expanded statewide between July 1, 2008 and June 30, 2010. AHCA planned to seek additional approval from the federal government to enroll more people in the reform program starting in 2010.