On Monday, state Sen. Joe Negron, R-Palm City, filed a Medicaid reform bill that would shift the bulk of Florida Medicaid patients into HMOs and other managed-care plans. Meanwhile, providers, advocates and patients continue to denounce Broward County’s Medicaid Reform Pilot program, which moved Broward Medicaid recipients into a managed-care model in 2006, as a failure.

Laura Goodhue, executive director of Florida CHAIN, which works on behalf of Medicaid patients and providers, says the existing waiver for the Medicaid Pilot program allows the state legislature and governor to move forward with efforts to develop a Medicaid managed-care model.

They need to push reform through before the existing Pilot waiver expires in June. If they don’t succeed, they would need a new waiver from the Center for Medicare and Medicaid Services, the federal agency that administers Medicare, Medicaid and the Children’s Health Insurance Program — a tall order.

Negron has said that if Florida doesn’t obtain a waiver, the legislature is willing to renounce up to $12 billion in federal funds — which would impact providers, hospitals, nursing homes, patients, businesses and private policy health insurance holders.

In a letter to the Center for Medicare and Medicaid Services, Gov. Rick Scott wrote that the Medicaid Reform Pilot is meeting “all waiver requirements,” asking the agency to allow the Pilot to continue. (See the full letter below.)

When asked about the Pilot program, Goodhue says her organization is “hearing that not all is well, for example with quality measures.” She says many of the HMO plans in the Pilot program are “low-performing.”

Goodhue says CHAIN has shown there are alternatives to provisions in the Broward Pilot program that would increase quality, protect consumers and hold managed-care plans accountable for taxpayer dollars. She says legislators seem indifferent.

“There is a way of developing coordinated care within Medicaid, where the patients are actively participating in their care,” Goodhue says. She describes programs in which “there is a good customer service; their needs are met; there’s a team of providers, specialists, social workers, case managers caring for the patient, making sure they get healthy.” She says the concept, “medical home care,” is a “key component of successful Medicaid programs nationally.”

Miriam Harmatz, staff attorney at Florida Legal Services, tells the Independent that research shows that cuts in basic services end up costing the health system more in the long term.

Florida Legal Services surveyed Broward county endocrinologists, dermatologists and pain management clinics listed as participating in managed-care networks and found that many no longer provide services through the Pilot program.

Harmatz has also studied the lack of any medical loss ratio requirements in the Pilot program plans. An 85/15 medical loss ratio, for example, means that 85 percent of the funding paid by the state to each HMO is actually spent on health care services for Medicaid recipients enrolled in the plan and 15 percent is spent on administration by the HMO or its subcontractors.

Harmatz says medical loss ratio requirements are important because if HMOs are spending more than 15 percent of the state dollars they receive for administrative and profit-related expenses, they are simply not going to have enough money left to cover necessary health care services.

Dr. Aaron Elkin, president of the Broward County Medical Association, tells the Independent all the data available on the Medicaid Reform pilot shows it has failed.

He says doctors and hospitals are not available for patients in the Pilot due to the hurdles imposed under the HMO model. He adds that Scott’s determination to cut the budget will only increase the Pilot’s problems, because there will not be enough doctors, hospitals and health workers to implement the program.

In 2008, a Georgetown University review of the Florida Medicaid Reform Pilot program (which you can read below) stated: “Available data suggest that the reform has not achieved many of its objectives.”

Scott’s letter:

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