By STEVE BOUSQUET, Times Staff Writer
Published September 1, 2005
TALLAHASSEE - Paging Medicaid patients in Florida: It's your turn to sound off on Gov. Jeb Bush's plan to overhaul the huge health insurance program.
The state on Wednesday released a detailed proposal to hold down Medicaid costs and limit fraud by shifting more patients to managed care plans like HMOs and encouraging new networks of doctors and hospitals. The state wants to move away from the current fee-for-service model that it says has led to rampant fraud and abuse.
Florida's Medicaid revamp would affect 2.2-million residents, many of them children, who are poor or have chronic health problems or disabilities. The plan would begin modestly in the spring in only two counties, but is being closely watched by experts across the nation.
Supporters, including most Tampa Bay area legislators, say the changes would cut costs and expand patient choice. But critics consider it a risky gamble at health care privatization. A skeptical Legislature endorsed Bush's goal of putting market forces in health care, but only after limiting it to about 250,000 patients in two test counties, Broward and Duval.
The Florida plan still needs a waiver from the federal government. A part of the review gives the public 30 days to register its opinions.
Florida's plan would offer Medicaid patients a choice of private health insurance plans. Providers would decide which services to cover. The state will encourage patients to take better care of themselves and their kids with more physical exams, dental visits and vaccinations.
"We provide incentives for consumers to do the things they need to do to stay healthy," said Alan Levine, secretary of the state Agency for Health Care Administration, which runs Medicaid in Florida.
Levine says the state's goals are patient choice, more competition in the health care marketplace and more primary care to improve patients' health, which he said will reduce Medicaid costs over time.
Joan Alker, senior researcher at Georgetown University's Center for Children and Families, has said Florida's goal of relying on competition among private insurers to save money, without reducing access to care, is an untested concept.
"It's not clear to me how many good new choices beneficiaries are going to get. But it is clear that the proposal gives HMOs new and unprecedented choices of how they're going to reduce services," Alker said in an interview.
Alker said a premise behind Florida's plan is flawed. She said the existing private health care market doesn't provide adequate coverage for people with chronic illnesses who are under Medicaid.
Florida expects to spend $17-billion on Medicaid next year if no changes are made. That's more than one-fourth of the current state budget. Even if the federal government grants Florida the Medicaid waiver it seeks, the Legislature must approve the plan again, possibly in a special legislative session as early as the week of Oct. 17. But Levine said the plan is dead unless the state and federal governments come to an agreement on how to compensate Florida hospitals for caring for the 2.6-million uninsured people in Florida.
Though the 30-day public comment period started Wednesday, Bush has been negotiating details of the plan with federal health officials for months. He recently voiced impatience that federal officials have not yet given their approval.
"We haven't gotten agreement yet. We're kind of getting near the end here," Bush said last week.
IT'S ON THE WEB
The detailed Medicaid proposal can be found at ahca.myflorida.com/Medicaid/medicaid_reform/index.shtml.
