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State not ready to begin Medicaid reform

Pilot programs modeled on private managed care need time to see if they work, officials say.

Associated Press
Published December 7, 2007

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TALLAHASSEE - Florida isn't ready to make Medicaid more like private managed care statewide, the state's health care agency said Thursday, announcing it won't push lawmakers to expand a test program next year.

The change in Medicaid to be more like the private managed care system was a linchpin of former Gov. Jeb Bush's health care agenda. It is being tried in five counties in a pilot program and has been expected to eventually become the statewide norm.

Agency for Health Care Administration Secretary Andrew Agwunobi said Thursday that it still might eventually expand to the entire state, but that the trial programs need to continue and be evaluated more before it does.

The agency this week gave lawmakers its priorities for the 2008 session and didn't include any move to expand the effort to overhaul Medicaid.

"This is not a statement about the long-term viability of Medicaid reform," Agwunobi said. "We simply do not feel at this point that the agency is ready to make a recommendation ... in this legislative session.

"There's more information we need to gather," said Agwunobi, who was appointed by Gov. Charlie Crist.

The move was presaged by a report issued by the agency's inspector general in October that recommended moving more slowly on revamping the system, noting that some recipients in the trial runs have had trouble choosing their health plan or their doctor.

The report also said it couldn't really be determined if the program is improving those people's care, as was promised, or is saving money, also a goal of the proposal.

Social services advocate Karen Woodall, who lobbied against many of the changes in how Medicaid services are delivered, said some Medicaid recipients have had trouble getting access to services and prescription drugs.

"I think it's a very responsible move on the part of the agency," Woodall said. "The whole point of doing pilot projects was to see if the concept worked in reality. And there's been a number of problems."

Linda Merrell, a health care consultant in Volusia County who has worked with Medicaid patients, said the new program has been rife with administrative problems for people moving between traditional Medicaid and new managed care plans, and for people moving from one managed care plan to another.

Bush and other officials had pushed hard to overhaul the Medicaid system that pays for most health care for the poor. Supporters of the overhaul have argued that the private managed care system does a better job of dealing with a person's health as a whole.

Traditionally, Medicaid recipients have gone to see a participating health care provider, who then seeks reimbursement from the government. The program's costs are split between the state and the federal government.

This summer, a federal government audit suggested that the plan to shift patients to managed care may illegally deny benefits to some children and pregnant women.

[Last modified December 7, 2007, 00:54:44]

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