Medicaid reform in Florida put on hold until next year

The Florida Medicaid system will not be reformed this year.

The sponsors of a plan to overhaul the system were unsuccessful in a bid to pass the bill before the state's legislative session ended April 30. The bill would have gradually transitioned most state Medicaid enrollees into managed care plans.

House leaders hoped that they could negotiate with the Senate, but they could not broker an agreement. The upper chamber had proposed a smaller overhaul of Medicaid than the House was willing to approve.

"The Florida House put forward a bold plan that transforms a broken system, and we did it through an open, exhaustive, collaborative and bipartisan process," said Rep. Dean Cannon, a bill sponsor. "Medicaid is one of the most complicated issues in state government."

Cannon and Rep. Denise Grimsley said they plan to bring the issue back during the 2011 legislative session.

Cannon said the House bill took a more comprehensive approach to fixing the state Medicaid system than did the Senate bill. "It would be easy to simply tinker around the edges of the system, but we chose not to allow political pressure to govern our actions. The House chose to push aside special interests, to take the high road and to try to fix a failed system."

But the Florida Medical Assn. opposes the bill, said FMA Executive Vice President Tim Stapleton. "The FMA has long opposed the expansion of managed care within the Medicaid program, and that would have happened under the Medicaid reform bill had it passed the Legislature."

Stapleton said the state should wait to receive reports on a smaller-scale demonstration of Medicaid reform before expanding it.

Florida is in the middle of a five-year Medicaid pilot project designed to encourage enrollees to take a more active role in managing their own health care. Qualifying participants in five counties are offered a choice of health plans with varying benefits. Plans include HMOs and provider service networks, which are owned by physicians and hospitals.

Two state-commissioned reports by the University of Florida released in 2009 found that the pilot reduced monthly spending on Medicaid enrollees with disabilities or chronic illnesses. But critics of the reports said they were not comprehensive enough and did not satisfactorily address the issue of cost reduction.

Stapleton said other reform models should be considered before jumping into the program expansion envisioned by Cannon and Grimsley.

The medical home as an alternative

The medical-home model has demonstrated that it can help lower Medicaid spending while increasing access to care, Stapleton said. He added that such homes can be implemented through many arrangements and do not require managed care.

The Florida Academy of Family Physicians opposed the Cannon-Grimsley bill and has argued for the medical-home model instead.

"There was a lot of concern among us who advocate for patients," said Tad Fisher, FAFP's executive vice president. "We think the local communities should make the choice of whether they would like a Medicaid HMO model or a patient-centered medical-home model."

Fisher said he appreciated that Cannon and Grimsley brought the issue to the forefront, even if lawmakers and organized medicine did not agree on the best way to go about fixing the program. "This is a huge issue, and from a positive standpoint, we were able to have a very open debate and excellent discussion about the value of using a medical-home model. I think at the end of the day they were never really able to resolve their differences, so we're pretty much kept at where we are."

The family physician organization released a report on medical homes along with the Florida Assn. of Community Health Centers and the Florida Osteopathic Medical Assn. in October 2009. It found that if states could lower Medicaid expenditures by just 1% each year through better preventive care, then hundreds of millions of dollars could be reinvested into better health outcomes for their citizens.

A conservative estimate puts annual Medicaid savings in Florida alone between $200 million and $900 million by fiscal 2012-13 if a statewide medical-home program were instituted, the report concluded.