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Panel holds off privatizing senior Medicaid care

A legislative committee delays a decision on a pilot program to await review of Gov. Bush's broader plan to transform Medicaid.

By ALISA ULFERTS
Published January 28, 2005

TALLAHASSEE - Lawmakers on Thursday postponed a proposal to shift thousands of elderly Medicaid patients into HMOs, saying it made little sense to do so in the midst of plans to revamp the overall state-federal public health program.

Had the legislators approved the plan, the state would have then applied for federal approval.

Instead, members of the joint Legislative Budget Commission held off on a vote - at least until after a series of hearings scheduled next month around the state to discuss Gov. Jeb Bush's plan to transform the nearly $15-billion Medicaid program into a government-funded insurance plan.

Elder care services comprise too large a chunk of the Medicaid program to be dealt with separately, lawmakers said, and shouldn't be privatized without more discussion.

"It's entirely unclear to me if we are ready to go there," said Sen. Rod Smith, D-Alachua.

The proposal called for Medicaid elder care services in Hillsborough, Orange, Polk and Seminole counties to be coordinated by managed care organizations. Pinellas had been part of the project, but was removed at the request of Sen. Dennis Jones, R-Treasure Island.

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 the private organizations.

As in Bush's current Medicaid revamp plan, the managed care companies would have received a flat fee per patient to cover all the care, instead of having the state-federal program reimburse providers directly on a fee-for-service basis.

The issue came up last year during the final days of the regular legislative session, but caused so much angst among senators that then-Senate President Jim King, R-Jacksonville, promised to hold off for a year to allow the proposal to be fully debated. The next day, senators were astonished to find the proposal tucked into three paragraphs of the 389-page state budget.

Lawmakers subsequently passed a separate bill to void that part of the budget, and instead directed the Agency for Health Care Administration to study giving Medicaid elder care services to an HMO. If the agency were to find a suitable area for a pilot project, the Legislative Budget Commission was to amend the budget in December, naming the area.

But there were still too many questions about the effects of privatizing all elder care services, and lawmakers and patient advocates said it made no sense to remove this part of Medicaid from the rest of the state's efforts to rework Medicaid.

"I think what they did made a lot of sense because long-term care is such a big part of Medicaid," said Florida Legal Services attorney Anne Swerlick, who represents Medicaid patients in disputes with the state. "It would be a huge change and it merits a full and open discussion."

[Last modified January 28, 2005, 00:20:16]