Report praises Medicaid pilot; Inspector General resigns
By Christine Jordan Sexton
7/18/2008 © Florida Health News
TALLAHASSEE -- A new report from a free-market think tank argues that Florida’s Medicaid pilot program has “numerous accomplishments” and should be expanded statewide. It contends that previous studies critical of the program -- including one by the Inspector General at the Agency for Health Care Administration – were flawed.
While it’s too soon to tell whether quality of care has improved over the pre-reform days of Medicaid, writes Cleveland State University finance professor Michael Bond, it’s clear that beneficiaries have increased services and products available to them and that doctors are sticking with the program. “The reform has unambiguously led to greater competition in all of the participating counties,” Bond wrote in the report, sponsored by the James Madison Institute in Tallahassee.
The positive evaluation of the Medicaid pilot project has begun to circulate at the same time as news of the abrupt resignation of AHCA Inspector General Linda Keen, the primary author of a critical report last September. Keen turned in her resignation letter to AHCA Secretary Holly Benson July 8; it said that while her last day would be Aug. 1 that she would not physically return to AHCA’s offices.
Keen didn’t return phone calls from Florida Health News on Thursday. However, the St. Petersburg Times’ politics blog reporters reached Keen at home; she confirmed that Benson asked her to resign. The Times quoted Benson as saying only, “Teams change with time.”
An RN and attorney who earned $115,000 a year, Keen was brought to AHCA by previous Secretary Andrew Agwunobi. Her report on problems in the Medicaid pilot was one factor that led Agwunobi to recommend that it not be expanded this year beyond the existing counties of Broward, Duval, Baker, Clay and Nassau.
Benson was the main legislative backer of the ambitious Medicaid pilot program during her tenure in the Florida House 2000-2006. Being tapped as AHCA Secretary in February put Benson in the peculiar position of having to support Keen’s critical report and carry out Gov. Charlie Crist’s decision to oppose expansion.
“I don’t know if we have all the data we need to make sure (Medicaid reform) is ready for statewide expansion,” she said diplomatically at the time of her appointment.
Florida’s Medicaid Reform pilot was passed in 2005, launched in Broward and Duval counties in 2006, and expanded into Baker, Clay, and Nassau counties in 2007. 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.
The idea behind Florida’s Medicaid reform project is to give managed care organizations, whether run by health care providers or insurers, flexibility in providing care for Medicaid enrollees so they can tailor services to patients' needs. In turn, Medicaid patients would get a choice of health plans, like most people who are privately insured.
Bond’s report for the James Madison Institute finds that Medicaid reform reduced costs 7.2 percent, increased access to specialists, provided more than 100 new services, reduced patients’ out-of-pocket costs and did a good job of retaining primary care doctors.
His analysis skewers both the Inspector General and Georgetown University’s research team. Keen’s report was based on interviews and anonymous surveys of AHCA employees, Bond wrote. He suggests that AHCA employees were opposed to the “political’’ decision to push ahead with the pilot program and were continually griping that they did not have enough money to carry out the reform effort. “It seems reasonable to assume that at least some of these individuals were opposed to the decision by elected individuals to implement the Medicaid demonstration,’’ wrote Bond, who said that it did not mean that all comments were inaccurate. But he added that Keen’s report that there were problems “would carry more weight if backed up actual evidence rather than opinion.”
The GU Health Policy Institute at least made an effort to gather data through focus groups and physician surveys, Bond wrote. But it was hampered by extremely small sample sizes and too limited a time frame for proper evaluation. Only 8 percent of doctors returned the surveys, he noted.
Joan Alker, principal investigator for the GU reports, downplayed Bond’s analysis, calling it nothing more than a critique. “I don’t see any new data,” she said.
It’s not surprising to see the James Madison Institute supporting expansion of the reform program statewide, she said, considering the think tank issued a paper in April 2005 calling Bush’s plan a “great first step towards building a real marketplace for Medicaid” and one that “deserves a fair trial.”
Alker questions the accuracy of Bond’s conclusions on cost savings. He used statewide data – including counties where the pilot isn’t running – instead of comparing Medicaid costs in the pilot counties now to before the reform program started, she said.
AHCA spokesman Doc Kokol said Keen’s replacement is Ken Yon, the bureau chief for Medicaid Program Integrity. Kokol said there is no connection between Keen’s departure and the new report that faulted her work.
Christine Jordan Sexton can be reached at cjordansexton@hotmail.com.
