Florida Health News

Budget includes hidden gift for Medicaid HMOs

By Christine Jordan Sexton
5/1/2008 © Florida Health News

TALLAHASSEE—Florida lawmakers are using the budget to quietly move thousands of additional Medicaid patients into HMOs, marking the second straight year in which the Legislature has used the end-of-session budget frenzy to make changes that could benefit WellCare Health Plans and other private corporations.

Tucked deep inside the 2008 budget is a requirement to shift patients out of MediPass, which pays a primary care doctor to act as the patient’s case manager, into a health plan if they live in a county with two or more such plans. Patients must affirm that they want to stay in the MediPass program; if they don’t speak up, the state will assign them to a Medicaid HMO or alternative managed care plan (a provider-sponsored network or a minority physician network).
 
The move will affect Medicaid patients in 25 counties, including Miami-Dade and Hillsborough. It becomes effective in October and is expected to save $51 million by June 30, 2009.
 
Florida Health News reported on Wednesday that most lawmakers, who receive health insurance free from the taxpayers, decline to enroll in HMOs themselves. 

Rep. Aaron Bean, chairman of the House Healthcare Council, wasn’t even aware that the 400-page budget contained the new enrollment requirement, but he still defended it. “It’s just for people who don’t voluntarily choose to stay in MediPass,’’ said the Fernandina Beach Republican.
 
There is nothing that legislators can do to eliminate the new requirement from the budget, because at this stage they can vote only up or down on the entire $66.2 billion spending plan. It’s reminiscent of last year, when a bill that hiked pay rates for Medicaid HMOs was passed in the waning days of the session. After reports appeared in newspapers, Gov. Charlie Crist vetoed it. 

Another provision in the pending budget would cut MediPass-participating doctors’ administrative fees by one-third, from $3 to $2 per patient each month. A program set up 17 years ago as an alternative to Medicaid HMOs, MediPass gives participating physicians a monthly case-management fee to coordinate care. In addition to the fee, the provider bills Medicaid for the care provided. 

Relying more on Medicaid HMOs is a good move for the state because they save money and improve care, said Bob Wychulis, president and CEO of the Florida Association of Health Plans. “Obviously, it’s something we support,” he said. 

Bean said physicians, who have not had their Medicaid rates increased for more than 20 years, used the monthly fee to pad low reimbursement rates. But in a year in which almost all health programs are taking cuts, reducing the case-management fee for MediPass doctors saves nearly $3 million, he said. 

Florida requires that most Medicaid beneficiaries be enrolled in some type of managed care, but includes MediPass as an option in all counties except those in the reform pilot program operating in Broward, Duval and a handful of rural counties near Jacksonville. Medicaid patients who don’t choose a plan are assigned to one by a company that contracts with the state Agency for Health Care Administration. 

Of the 62,000 new Medicaid enrollees January through March, an AHCA report shows, more than half made a choice but about 27,000 were given an assignment. Of those, 22,500 were sent to an HMO or other network plan. About 4,600 were assigned to MediPass and 10,000 chose it voluntarily. 

“It’s a backdoor way to get everybody into HMOs,” said Karen Woodall, a long time social service activist. 

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