Report: Only 10% of Medicaid credits were used
By Christine Jordan Sexton
7/24/2008 © Florida Health News
TALLAHASSEE - A key component of Florida’s Medicaid pilot project -- awarding points toward free products to patients who display healthy behaviors -- has not been used by most of the people it was intended to help, an analysis released Thursday says.
Medicaid patients accumulated $12.5 million worth of credits in the first 18 months of the Enhanced Benefits Reward Program, which began in September 2006. But only 10 percent had redeemed them as of March, according to researchers at Georgetown Health Policy Institute.
In a prepared response, Secretary Holly Benson of the Agency for Health Care Administration said: "We are seeing increased participation in the enhanced benefits program, and every month more of our beneficiaries are taking advantage of their benefits. Our team and our partners have worked to enhance the program to make it more meaningful for our beneficiaries, and we will continue to refine it to ensure that it encourages the healthy behaviors the Legislature sought to promote."
The administrative costs of the program were $1.1 million, an amount that Joan Alker, co-principal investigator, called "startling" during a teleconference. The four-page brief, "The Enhanced Benefits Rewards Program: Is it changing the way Medicaid beneficiaries approach their health?" is posted at the institute's web site.
"Lackluster redemption of the credits beneficiaries are earning and high administrative costs raise questions" about whether the approach is worth it, the report concludes. "Little evidence is available to show whether health outcomes have been improved.”
Every person participating in Florida’s Medicaid pilots, now operating in Baker, Broward, Clay, Duval, and Nassau counties, is eligible to receive up to $125 a year in credits for making wise choices, such as keeping a doctor's appointment, taking children to their check-ups and getting them vaccinated. Credits can be used to purchase over-the-counter pharmacy products such as sunscreens, eye drops, diapers and laxatives. Former Gov. Jeb Bush said the credits were one of the best things about the pilot program, which requires most Medicaid beneficiaries to be enrolled in an HMO-style plan from a private company or health network.
Nearly 60 percent of the credits have been earned for keeping doctors' appointments, and another 20 percent are for being screened for health problems and taking medicines as prescribed. All these points are easy to earn because the Medicaid program gets them from the claims forms submitted by health-care providers, Alker said. But the report said few credits were recorded for activities that require beneficiaries to fill out a form and get it signed, such as for exercise or stop-smoking programs.
Another problem that researchers found when they talked to Medicaid beneficiaries: Many weren't aware that the program exists. Those who said they knew about it were "enthusiastic," but admitted to researchers that that they were being rewarded for things would probably have done anyway.
Researchers said three-quarters of the physicians Georgetown surveyed weren’t familiar with the program. Those who were tended to be skeptical that it would succeed, the report said.
This was the second report in a week on Florida’s Medicaid reform pilot program. One that Florida Health News wrote about last week -- sponsored by a Tallahassee free-market think tank, the James Madison Institute – contended that prior reports by the Georgetown team and the inspector general of the Agency for Health Care Administration were flawed and had ignored good news about the program. JMI focused primarily on whether patients had access to more health plans and services than before the pilot program began and whether it was saving taxpayers money.
The report by the Georgetown University team is the sixth in a series, sponsored by the Jessie Ball duPont Fund in Jacksonville. (Disclosure: The duPont Fund is one of the seven foundations in Florida that have made grants this year to Florida Health News).
