Pushing poor mental-health patients into HMOs might save the state some money, but at what cost to families and communities?
Published April 14, 2004
Florida's House Republicans appear hell-bent on rewarding for-profit health maintenance organizations at the expense of the poor. Under their plan - approved with little study or public debate - Medicaid recipients would have to seek mental health treatment through HMOs, not the community-based centers that have performed the task long and well. The House plan would cut both services and jobs and is one Florida cannot afford.
The proposal (HB 1843) would force hundreds of thousands of adults and children, struggling with major depression, bipolar disorder or other forms of mental illness, to move into HMOs or change providers if they are already enrolled.
This far-reaching change was not the brainchild of state experts - Florida's Agency for Health Care Administration is not even recommending it this year - but rather the handiwork of industry lobbyists. Is it only a coincidence that HMOs, including WellCare of Tampa, have pumped thousands of dollars into the U.S. Senate campaign of House Speaker Johnnie Byrd?
Lawmakers are right to try to rein in Medicaid spending, but a stealth provision, with little state analysis and the stench of payoff, is not the way to do it. The change would undermine the schedule and strategy lawmakers laid out only last year and ignore HMOs' spotty record of caring for the mentally ill.
HMO clients receive fewer mental-health services and are less likely to get the newer (and better) psychiatric drugs, according to the Florida Mental Health Institute in Tampa, which has been tracking several mental-health managed-care pilot projects for years.
It's not hard to guess why: HMOs deny access or make patients jump through hoops even those of healthy mind find hard to navigate. Providers argue, with proof, that HMOs use the government's mental-health dollars for other purposes, including profits.
Pushing poor mental-health patients into HMOs may indeed save the state some money - especially if lawmakers do what the HMOs want by simply expanding existing contracts, not requiring rebidding. But at what cost to families and communities? More untreated patients would end up on the streets or in jail, while more employees would be out of work once the estimated $130-million is drained from Florida's network of public mental-health centers.
The costly plan is headed to the budget conference committee, where senators should stand firm against the House and the HMO lobbyists pushing the bill. Florida's underfunded mental-health system is already among the poorest in the nation. Lawmakers should be putting money into services, not into the pockets of HMO executives.
