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New Medicaid pilot in the works?

3/30/2009 © Florida Health News
Medicaid Reform could branch off in a new direction under a proposal that could emerge from a House committee this week. It would set up "medical homes" for patients using community health centers, based on the famed Mayo Clinic model of having a whole team consulting on a patient's needs in one site.

The proposal, which would be launched in four counties, is to be introduced in the House Council on Health and Family Services, according to a patient advocacy group familiar with it, Florida CHAIN (Communtity Health Action Information Network). The group says the proposed committee bill will emerge this week, but the staff of Rep. Ed Homan, Council chair, could not immediately confirm the accuracy of CHAIN's information Monday morning.

The "medical homes" would be community health centers for primary care and medical schools for specialty care, CHAIN said. The test counties for the medical-home pilot would be Miami-Dade, Orange (Orlando), Hillsborough (Tampa) and Alachua, according to CHAIN's summary of the proposal. All four counties have medical schools.

The proposal would make "significant and helpful changes to Florida Medicaid, particularly to Medicaid managed care,"  CHAIN said in a press release. The proposal would not expand or significantly change the existing Medicaid Reform pilot, now active in five counties.

Each patient would have access to an interdisciplinary team led by a primary care provider. While the clinic managing the patient's care would not be paid as HMOs are now, through capitation (a fixed fee per patient each month), the clinics would have an incentive not to waste money  because they would share in any savings.

The CHAIN summary of the proposed bill says it would include a couple of minor changes to the existing Medicaid Reform pilot, which relies more on corporate HMOs than on non-profit networks and operates in Duval, Broward, and three rural counties in northeast Florida.  CHAIN has been vocal in criticism of the Medicaid Reform pilot in those areas, saying it has been hard on both patients and doctors.

The expected Council bill would expand the gathering of data on treatment provided to Medicaid patients enrolled in managed-care plans. Currently those "encounter data" are gathered only in the existing "Reform" counties, not among patients enrolled in HMOs in other counties.

The proposed bill also would speed up the shift in the pay structure to provide higher premiums for sicker patients and lower premiums for low-risk patients. This is designed to discourage plans from selectively enrolling those who cost the least.
Meanwhile, on the mental-health front, advocacy groups are alerting members to lobby against a Senate budget proposal that would reduce community funding for mental health and substance abuse services by more than $13-million. 

Treatment cuts would include $8.7 million in adult mental health, $2.1 million in adult substance abuse and $2 million for child substance abuse, according to a fact sheet provided by Partners in Crisis, a group that wants to end the jailing of the mentally ill by providing preventive care in communities.

The Senate Health and Human Services Appropriations Committee also eliminated $2 million in reinvestment grant funds, leaving $1 million in the criminal justice budget.

"These cuts are a tremendous blow to a system already suffering from too little funding," according to the Partners release.

--Contact Editor Carol Gentry at this e-mail or at 727-410-3266.