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Legislature 2004

Proposal could switch Medicaid patients to HMO

Senators react angrily when the plan, thought to be dead, shows up in the state budget.

Published April 29, 2004

TALLAHASSEE - A plan to shift thousands of elderly Medicaid patients into HMOs surfaced in the state budget Wednesday, causing an uproar among senators who thought the proposal was dead.

The proposal was tucked into three paragraphs of the 389-page document despite assurances from Senate President Jim King that it would be kept out of the state spending plan, which lawmakers cannot change.

Under the plan, all Medicaid services for seniors, including nursing homes, assisted living homes, adult day care and home-delivered meals, would be coordinated by managed care organizations in Hillsborough, Orange, Polk and Seminole counties.

Pinellas was originally part of the project, but was removed at the request of Senate Majority Leader Dennis Jones, R-Treasure Island.

The pilot project also was tacked onto a bill senators briefly debated Wednesday but did not pass.

After hearing from senators who didn't want their counties included, King said he would seek a fix. "Enough angst has been raised," King said.

The final budget agreement reached in House-Senate negotiations landed on lawmakers' desks Tuesday evening. By law, they must wait 72 hours for a final vote, and they can only accept or reject the deal, not change it.

To kill the proposal, lawmakers must pass legislation directing the state to ignore that part of the budget. Senate budget chairman Sen. Ken Pruitt, R-Port St. Lucie, said he reached a deal with the House to pass a bill ordering the state Agency for Health Care Administration to study giving Medicaid elder care services to an HMO.

If the agency finds a suitable area for a pilot project, the state can amend the budget in December.

"I think the case needs to be made for why this is a good idea, and it hasn't been made yet," said Senate Democratic leader Ron Klein. The state needs a public debate before trying something so dramatic, Klein said.

Under the plan, everyone older than 65 who needed Medicaid would have to sign up. The state would pay an HMO a fixed rate for each of them, and the HMO would determine the level of care.

The plan, backed by managed care companies, would be a dramatic change in how Florida provides long-term care to the elderly, turning over decisions made by government and local nonprofit agencies to private insurance companies.

Sen. Durell Peaden, a Crestview Republican who supports the plan and wants to take it statewide, assured senators the plan had been fully debated in public meetings.

"This is not new. This is not the first time we've done this," Peaden said.

But he failed to convince his fellow senators.

"Probably 83 percent of all the complaints I get in my office are people complaining about treatment under HMOs," said Sen. Walter "Skip" Campbell, D-Fort Lauderdale.

Tony Marshall, director of reimbursement for the Florida Health Care Association, a trade group for nursing homes, said he was relieved the state planned to study the issue.

"They can't do that in a vacuum," Marshall said. "They never really gave it a proper hearing."

The budget also includes a provision to expand statewide a pilot project directing Medicaid mental health patients into HMOs, a move that could affect up to 600,000 Medicaid patients. [Last modified April 29, 2004, 01:35:43]

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