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Top Story‘Stay the course,’ don’t expand Medicaid Reform yet, evaluator says By Carol Gentry, editor GAINESVILLE – A University of Florida professor hired to evaluate Florida’s Medicaid Reform project says there isn’t enough information yet to justify expanding it, which the House Speaker wants to do.
Florida’s five-year demonstration project requires that Medicaid patients – children, pregnant women, and disabled and elderly persons who have extremely low incomes – be enrolled in a private HMO or other managed-care plan unless they are in an institution, such as a nursing home. The five-year demonstration project went into effect in July 2006, but enrollment got under way only 18 months ago.
Legislators haven’t asked his opinion on expanding or shrinking the program, Duncan said, but if they did, he’d tell them to “stay the course” until more time passes and more data are collected. “We don’t have evidence in either direction to slam the door [on Medicaid reform] or fling it wide open,” the professor said.
Duncan’s team provided Florida Health News with a copy of some preliminary findings based on just a few months’ data:
These findings, while carefully documented, are merely preliminary, the draft report says. Evaluations of this type require two or three rounds of surveys to identify trends, it says. In the first round it can be hard to distinguish whether problems are a result of inherent flaws in the program design or the rollout of the program.
“Stronger and clearer answers to the core questions will not emerge until the demonstration has been in place for sufficient time to see how it is working and to better understand the impact on enrollees,” the draft report says.
Until there is clear evidence, “demonstrations should be neither expanded nor contracted while they are still in progress,” it says. “Everyone should resist the temptation to declare success or failure.”
Near the end, the draft report observes that “it is not particularly helpful for participating organizations, observers, commentators, editorial writers, advocates or others to prejudge the outcomes.”
A number of newspapers in the state have been critical of the pilot project. For example, The Palm Beach Post published an editorial on Christmas Eve that called Medicaid reform a “failed experiment.”
In a series of interviews with Florida Health News, Duncan admitted that such pressure has made him reluctant to talk about Medicaid reform at all because proponents and critics pick apart everything he says to find any trace of bias. Opponents of the pilot program are especially suspicious, as his team’s research funds come from state officials who naturally want the program to work because it saves money.
But Duncan, who is nationally known for his research in other states as well as Florida, said his only allegiance is to science. “I start at neutrality; I don’t care” whether the pilot program gets expanded or killed off, he said.
Currently the program is operating in metro Fort Lauderdale and Jacksonville, as well as three rural counties. At its present size of five counties, the experiment is “big enough to draw conclusions at the end of five years, valid ones,” Duncan said. “But it’s small enough to be an honest demonstration project.” Such a project applies a theory to a limited population to see whether it works before taking it full-scale.
House Speaker Marco Rubio said last week that he wants to move the project into Miami-Dade, Florida’s most populous county. Rep. Aaron Bean, chair of the Health Care Council, said he would carry the ball for Rubio’s proposal through the House in order to sustain momentum for the reform project.
“Medicaid is eating our lunch,” said Bean, R-Fernandina Beach.
The Legislature must make massive cuts in the budget this year because of sagging tax collections.
But Duncan says that if Miami-Dade were added to the current enrollees in the project, 65 percent of the state’s Medicaid population would then be engaged in the project. “Inertia” would take over, and it would become a statewide program, Duncan said.
Former Gov. Jeb Bush pushed the reform project to curb the growth of Medicaid spending, which is supported jointly by federal and state funds. It passed the legislature in 2005 and went into effect in July 2006 after the U.S. Department of Health and Human Services granted Florida a waiver of the usual Medicaid rules. A Government Accountability Office report released this week said HHS erred by allowing Florida $6 billion more over the five-year project than it should have.
Patient advocates have protested the plan since it was first suggested, in part because they worry that corporate HMOs will pinch pennies and make access to expensive services difficult for persons who are ill-equipped to fight for themselves. Also, advocates dislike the fact that Medicaid patients in reform counties are automatically assigned to plans if they don’t make a choice on their own, and are locked in for a year.
“In any arena, people should have a choice,” said Lori Parham, director of AARP-Florida.
Complaints from some beneficiaries about difficulty obtaining approval for referrals and prescriptions have persuaded the advocates there is reason for concern. With help from Legal Services, several patients recently filed a class-action suit.
Last week in Miami, a former Medicaid director and former chief of the Agency for Health Care Administration both called for the state to explore alternatives to the current reform project. They cited an AHCA inspector general’s report that raised questions about the program and the decision by former AHCA Secretary Andrew Agwunobi to rule out expansion until more is known about how it’s working. The new AHCA Secretary, Holly Benson, helped shepherd the reform project through the legislature when she was in the House, but she has said she will not push for expansion without evidence that it’s safe.
Carol Gentry, editor of Florida Health News, can be reached at Carol.Gentry@FloridaHealthNews.org or 727-410-3266.
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