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Medicaid choices could narrow

By Christine Jordan Sexton
2/2/2010 © Health News Florida

This could be the year the state of Florida eliminates its popular MediPass program, which gives more than half a million Medicaid recipients, mostly aged and disabled Floridians, an alternative to HMOs. Hints of its demise showed up in the governor's budget and letters from a powerful lawmaker.

The fight brewing in Tallahassee is over what service delivery system will take its place:  commercial HMOs, hospital-run networks or a system that puts the primary care physician in charge.

The Legislature is closely examining the MediPass program, which as of January had about 550,000 enrollees statewide, in an effort to control spending in the Medicaid program. Although it's considered a managed-care option, MediPass is actually a primary care case-management program, in which doctors are given a monthly $2 fee for managing a patient’s care. The services, such as immunizations and checkups, are reimbursed at Medicaid rates.

Hints at the looming demise of MediPass showed up in letters to health care executives last month from Rep. Dean Cannon, chairman of the House Select Policy Council on Strategic and Economic Planning. Cannon asked Tim Goldfarb, CEO of Shands Healthcare, what the impact on the "safety-net" hospital would be if the state eliminated MediPass. 

Even Gov. Charlie Crist’s budget, which was criticized by the Legislature as being overly optimistic, eliminated the $2 fee for MediPass participating physicians.

“There just doesn’t seem to be the political will to save it,” said Tallahassee attorney Anne Swerlick, Deputy Director of Florida Legal Services.

Florida Medicaid offers health care to eligible recipients through two main types of delivery systems: fee-for-service and managed care. Even though MediPass in many respects looks a lot like traditional fee-for-service Medicaid, the state lists it as a managed-care option. Others include hospital-run networks, commercial HMOs, and minority physician networks.

The state already has authority from the federal government to assign many people into managed care, including the aged and disabled and many women and children. Unless a patient lives in Broward, Duval, Baker, Nassau or Clay counties, and is part of the Medicaid Reform pilot program, MediPass is considered a managed care option.

Florida cannot force other Medicaid patients—namely poor and elderly who are eligible for nursing homes—into managed care without additional authority from the federal government.

If Florida eliminates MediPass as a managed-care option, how will the patients be served? One idea is a "medical home," which centers on the primary care physician. It is endorsed by Rep. Ed Homan, a Republican from Tampa and orthopedic surgeon.

 A report by the Medical Home Advisory Task Force, which  met for five months, was released today.  It recommended that the Legislature move ahead with a model that authorizes the state to develop a three-tier medical home model, in which a health care provider is available to Medicaid patients at all times.  

The task force was asked to recommend two pilot sites, but said a separate committee should be appointed to decide that. The report did say there needs to be at least one rural area and at least one urban area that has a medical school.

Another alternative, from the Florida Association of Health Plans, would be to require every MediPass patient who lives in a county with two or more HMOs to enroll in a Medicaid HMO, with an annual open-enrollment period. Patients who don’t voluntarily choose a health plan would be assigned to one. Plans that scored highest on quality and performance measures would receive more patients than those scoring lower.

The FAHP estimates that the state saves $22 million for every 100,000 people it moves from MediPass to HMOs.

--Christine Jordan Sexton is co-founder of