Florida Health News

Medicaid Reform may expand to Dade; advocates call for alternatives

By Carol Gentry and Christine Jordan Sexton
2/29/2008 © Florida Health News

MIAMI -- House Speaker Marco Rubio’s announcement this week that he wants to expand Medicaid Reform to Miami-Dade cast a pall over more than 100 doctors and patient advocates who met Thursday to call for changes in the project.

L-R: St. Petery, Adam Searing of North Carolina's Community Care Program; Cook; and Sharpe

Among the speakers at the seminar, “Exploring Alternatives to Medicaid Reform,” were a former Florida Medicaid director, Bob Sharpe, and Doug Cook, former chief of the Agency for Health Care Administration.

Both said it would be a mistake for the Legislature to expand the existing pilot program – which is dominated by corporate HMOs -- before there is evidence that patients are being properly cared for. They cited a critical report in September by AHCA’s Inspector General, which led then-AHCA Secretary Andrew Agwunobi to place plans for expansion on hold. A class-action lawsuit on behalf of Medicaid patients who say they were denied treatment is also pending.

“We have Wall Street controlling public health, looking at short-term gains instead of long-term investments,” said Cook, who led AHCA during the administration of the late Gov. Lawton Chiles in the 1990s. “Their expectation is on the return (on investment), not on improving access to the health-care system.”

Rubio’s health priorities for the coming legislative session also include the development of electronic medical records and health coverage stripped of “mandates,” legal requirements for coverage of specific treatments and services. Rubio’s mandate-free coverage would not have to be available to all who want to buy it, unlike the proposal by Gov. Charlie Crist.

Florida Health News was unable to contact Rubio for more details on his expansion plans for Medicaid reform. In a prepared statement, the Speaker said he didn’t want to wait because the current system is financially “unsustainable.”

Rep. Aaron Bean, chair of the Health Care Council, said he will shepherd the Speaker’s proposal through the House because it’s important to sustain momentum. “Medicaid is eating our lunch,” said Bean, R-Fernandina Beach. If federal and state funds are combined, Medicaid accounts for about one-quarter of the state budget, up from 6 percent in 1980.

The Florida Association of Health Plans welcomed Rubio’s proposal for expansion into Miami-Dade. Bob Wychulis, president and CEO, said he thinks the complaints against the Medicaid managed care plans “are not excessive.”

AHCA spokesman Doc Kokol said the agency would not advocate a position, but would supply information. The agency has contracted with the University of Florida to provide analysis of the pilot project over a five-year period. The first tentative data are to be released around May.

Florida’s Medicaid Reform pilot, which began in 2005, is now in place in Broward, Duval and three smaller counties. It requires virtually all Medicaid beneficiaries who aren’t in institutions to enroll in an HMO or other managed-care network. If they don’t choose one for themselves, they’re automatically assigned to one – and not necessarily one that meets their needs, said Dr. Louis St. Petery, one of the speakers at the seminar.

A pediatric cardiologist in Tallahassee, he showed the audience a picture of a woman and her five children, who he said are assigned to three different health plans. “She’s been trying to get it changed, but they’re locked in,” St. Petery said. “And this is everyday, not just something that happens on an occasional basis.”

Former Medicaid director Sharpe said he’s not arguing for a return to the past, even if that were politically possible. “There were all kinds of problems finding access to specialists, low reimbursement rates, and poor outcomes” in traditional Medicaid, he said. “Medicaid reform isn’t the issue. Managed care is the issue.”

It will do no good just to oppose the expansion of the program, he said. Instead, patient advocates need to propose an alternative that will provide the savings that the Legislature seeks while improving access to care for the 2.2 million Floridians who have incomes low enough to qualify for Medicaid, including children, pregnant women, the elderly and disabled.

Sharpe suggested a “do-over,” calling it “Medicaid Reform II.” The state would encourage development of different kinds of managed-care networks, ones that are specially suited for different groups with different needs. And it could require plans that contract for the business to spend 85 to 90 percent of the money they receive from taxpayers on patients, rather than the 70 to 80 percent that corporate HMOs favor, with the rest going to administration and profits.

Now president of the Florida Council for Community Mental Health, an association of centers that treat outpatients who have mental health and substance abuse problems, Sharpe has been leading them to form a service network that could compete for care of the hundreds of thousands of Floridians they now serve. Because the centers are non-profits and their administrative costs are lower than the corporate HMOs, Sharpe said, they could do a better job for less money.

“We think we can play in this game,” Sharpe said. “The state could (save) more money with us.”

Similarly, some federally-designated community health centers in Florida are also planning to compete. One group, which has created a non-profit corporation to apply for a Florida license as a Provider Service Network under the name Prestige Health Choice, has hired Cook, the former AHCA director, as executive vice president.

Cook took this route after trying to persuade corporate health plans to expand access to care. While there are competent and caring individuals in the companies, he said, “the corporate mindset is to make money. As much as they can as soon as they can.”

The meeting, held at University of Miami’s Mailman Center for Child Development, was also sponsored by Florida CHAIN, an advocacy group; Health Foundation of South Florida; The Children’s Trust; the Human Services Coalition; and the Collins Center for Public Policy. (Disclosure: The Health Foundation of South Florida provides financial support for Florida Health News).

Carol Gentry, editor, can be reached at 727-522-4876 or Carol.Gentry@FloridaHealthNews.org. Capital Correspondent Christine Jordan Sexton can be reached at cjordansexton@hotmail.com.

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Medicaid Reform may expand to Dade; advocates call for alternatives

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