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Crist: Keep $ for health clinics

By Christine Jordan Sexton
3/12/2009 © Florida Health News

Gov. Charlie Crist’s proposed budget would remove a funding threat to five county health departments that was due to take effect in September as part of Medicaid Reform.

As Florida Health News recently reported, public health analysts were predicting county clinics would lose millions of dollars a year and no longer be able to care for the uninsured if the payment formula changed.

“I think this is fantastic news,” said Earl Fox, director of the Florida Public Health Institute in Lantana, when informed of the decision today. “The governor is to be complimented on it and I hope the Legislature agrees.”

Crist had already said he would hold off on expansion of the pilot project until a state-commissioned assessment is complete, a process that could take several more years. But some in the Legislature have championed expansion of the program statewide as a cost-saving measure.

The pilot project, which began in 2006, requires most every Medicaid patient in Duval, Broward and three smaller counties to enroll in a managed care plan.

“County health departments are a key primary care safety net provider for many, many beneficiaries,” said Tom Arnold, chief of staff for the Agency for Health Care Administration, parent agency for Medicaid. “The governor feels they should be protected. That’s what this provision will do.”

The move to keep funding intact for the county health departments in the five Medicaid Reform pilot counties is only a recommendation. It still needs to be approved by lawmakers, who have been skeptical of the governor’s proposed budget recommendations to date.

Medicaid now pays the departments the cost of running their clinics, where many of those treated are uninsured Floridians who don’t qualify for Medicaid. Without the exemption, the departments won't have the financial cushion to subsidize care for the uninsured.

Paul Metts, former deputy secretary of the Department of Health, recently concluded that the change in reimbursements would mean an $8 million reduction for the Duval County health department and about a $2 million reduction for the clinic in Broward County. 

The flow of untreated, uninsured patients into hospital emergency rooms could have a $1.5 billion impact,  Metts calculated.

The looming change has panicked county governments, which contribute to the cost of running the health department clinics, said Florida Association of Counties lobbyist Heather Wildermuth.

“I’m very encouraged to hear the news,” said Wildermuth. “I hope (lawmakers) adopt the governor’s position.”

Arnold made the announcement at a Wednesday afternoon workshop on a Medicaid Reform bill (HB 1261) filed by Rep. Janet Adkins, R-Fernandina Beach. She represents rural northeast Florida, including the three rural counties that are part of Medicaid Reform – Nassau, Baker and Clay. Adkins has expressed concern about lower funding for health departments as well as slow reimbursement to providers under the pilot.

Florida Association of Health Plans is watching the recommendation closely, said Michael Garner, president and CEO. Medicaid HMOs tend to frown on exemptions from Reform requirements, including county health departments.

Arnold said county health departments are the only providers that would be exempted from the fixed-premium “capitation” system. Hospital- or physician-owned “provider service networks,” which have been paid under a traditional fee-for-service arrangement, will shift in September to the capitation system used by HMOs under the governor’s budget.

If the Legislature agrees, said hospital lobbyist Jan Gorrie, the Shands-Jacksonville provider service network will receive $11 million less from Medicaid next year. 

-- Contact Christine Jordan Sexton. Editor Carol Gentry contributed to this report. E-mail her or call 727-410-3266.