Legislature rushing to shift Medicaid to Managed Care

[Guest guest]

Speaker Cretul seems to have a conflict of interest when it comes to managed care proposal, wouldn't you say? Furthermore, skewed data show that the cost savings come at the expense of shifting expenses to consumers. Read below.

First, show that reform works: Legislature rushing to shift Medicaid to managed care

The Legislature's proposed overhaul of Florida's $18 billion Medicaid program would benefit insurance companies, not patients and taxpayers.

Bills that would expand the state's yet-to-be successful Medicaid reform experiment have sailed through House and Senate committees. The full House is expected to approve its measure this week. The bills mandate that beneficiaries get treatment under managed care programs, essentially turning Medicaid over to private insurers.

Rep. Mark Pafford, D-West Palm Beach, was right when he said the Legislature is moving too fast. "The speed at which this bill is moving," he said, "does not make much sense."

The tangle of interests involved in the push for statewide managed care takes some unraveling. It was recommended by the Pacific Health Policy Group, a consulting firm with whom House Speaker Larry Cretul, R-Ocala, signed a $105,000 contract. Pacific lists as a client WellCare Health Plans of Tampa, whose companies, Staywell and Healthease, are the largest Medicaid HMOs in the state. Pacific is a division of Westport Healthcare Management Inc., whose former president and CEO, , now runs Schaller , Aetna's Medicaid division. Schaller administers Integral Quality Care, a new player on Florida's medical scene that on April 1 began administering Medicaid programs in Collier, Manatee and Polk counties with plans to add more counties in the future.

The bills would expand a five-county Medicaid reform pilot initiated under Gov. Jeb Bush that began in 2006. The pilot forced about 250,000 Medicaid recipients in Broward, Baker, Clay, Duval and Nassau counties into managed care programs.

University of Florida researchers found that while costs declined in the first two years, they couldn't determine whether the savings were the result of more efficient care or because fewer patients used the system. In June, the Florida Office of Program Policy Analysis & Government Accountability — the Legislature's watchdog agency — advised lawmakers not to expand the pilot until data demonstrate that it has improved both access to and quality of care.

Garner, president and CEO of Florida Association of Health Plans, contends the pilot has done both. Pointing to studies, such as those done by the Lewin Group, he said managed care helps to cut fraud and abuse in the Medicaid program and guarantees cost savings to the state. He estimates Florida will save between 3 percent and 15 percent in Medicaid expenditures.

The Lewin Group is wholly owned by UnitedHealth Group, one of the nation's largest insurers. It is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association of helping insurers shift medical expenses to consumers by distributing skewed data.

Goodhue, executive director of Florida's Community Health Action Information Network, said her group has asked lawmakers to vote against expanding reform. "It just hasn't proven to increase the quality of care or save taxpayers dollars," she said. "It's just too risky to expand this model statewide."

Ms. Goodhue pointed out that the state received a research and demonstration waiver from the federal government to do the pilot and there has been no independent research showing the program works. "You should have some results to show either way so we can make an informed decision, and we don't have that," she said. "What we do have are a lot of stories from people who haven't been able to access care."

Despite this, lawmakers are rushing to expand the program. The Senate bill, sponsored by Sen. Joe Negron, R-Stuart, would cap Medicaid's annual budget, require that recipients meet co-pays and deductibles, and offer vouchers for recipients to buy private insurance. The plan also would move an additional 247,671 Medicaid recipients from 19 counties, including Miami-Dade and Palm Beach, into HMOs. The House bill would force all 2.7 million Medicaid enrollees into managed care within the next five years by dividing the state into six regions with managed-care plans, including HMOs and hospital doctor groups, serving each region.

There's no question that changes to Medicaid, which eats up 19 percent of the state budget, are necessary. Florida lawmakers, however, should make sure reform works before pushing it on the entire state.

Regards,

Ven Sequenzia

President

Autism Society of America

State of Florida Chapter