‘Reform’ will lose its biggest player

Feb 4, 2009

By Christine Jordan Sexton and Carol Gentry
 2/4/2009 © Florida Health News 
TALLAHASSEE -- WellCare Health Plans, Florida's largest Medicaid HMO contractor, will pull out of the "Reform" project in Broward and Duval counties on May 1, according to the Agency for Health Care Administration, which released a letter concerning the move.
Tampa-based WellCare has about 41 percent of the market in the two counties, with over 78,000 members in its plans HealthEase and Staywell. But AHCA spokesman Fernando Senra insisted the loss of the pilot's major player won't bring the controversial project to a halt. "We're confident that we have the capacity in those counties to provide for (the patients)," Senra said.
An e-mail sent to a Medicaid official last week had said WellCare might leave 11 other counties as well, outside the pilot-project zone, but the company changed its mind. WellCare's HMOs will still have Medicaid members in 32 counties, Senra said. He said the company didn't give a reason for the pullout.
A WellCare spokeswoman said the company would not discuss the decision until it files the information with the Securities and Exchange Commission, as is its policy. That should happen today, Amy Knapp said.
WellCare's decision deals a blow to those who hoped Florida's bold plan to move all Medicaid patients into HMOs and doctor-sponsored networks would succeed in saving money for taxpayers and improving access to care for the poor who depend on the program for medical care. The project, created by former Gov. Jeb Bush and endorsed by the Republican-led legislature in 2005 and 2006, required and obtained a waiver of federal Medicaid rules to go into operation.
Broward (Fort Lauderdale) and Duval (Jacksonville) counties were the first ones in which Medicaid patients were forced to enroll in HMOs or similar networks, beginning in 2006. Later, several rural counties around Jacksonville were added. 
Some in the Legislature tried to add more counties to the pilot last year, including Miami-Dade, but an outcry from patient advocates stalled the effort.
AHCA's legislative agenda for 2009 included a try for expansion of the pilot, but when questioned about it in the fall, an agency spokesman said no decision had been made, that the agenda item was merely a "placeholder."
The University of Florida is conducting a five-year study of the project under contract with the state. Its principal investigator, Paul Duncan, told Florida Health News recently that he cannot tell from the data he's collected whether Reform saves money for the taxpayers or improves patients' health. He'll need to wait to get actual patient outcomes from data that are only now being collected by the participating plans.
AHCA's Senra said that the state would begin notifying the members of their options to enroll in other managed care plans within the next month. Patients who don't voluntarily enroll in another managed care plan will be automatically assigned to one, he said.