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Crist: ‘Medicaid Reform’ can grow

By Christine Jordan Sexton
2/10/2010 © Health News Florida
After opposing expansion of ‘Medicaid Reform’ for three years, Gov. Charlie Crist said Tuesday he’s “open” to seeing it grow beyond its current five Florida counties.

Crist said the program, which requires most Medicaid recipients in the five pilot counties to enroll in managed care plans, gives the state "the ability to exercise options' in its Medicaid program. 

But the governor said he probably would not support a proposal that would limit expansion to HMOs. Other kinds of networks – led by hospitals or minority-physician groups – are active in Medicaid Reform now. 

“I think having choices is always good,” Crist said. 

The governor’s remarks come as legislative budget committees are wrangling with a revenue shortfall of as much as $3 billion. Medicaid -- a $19-billion state and federal program that pays the health care costs of the poor, elderly and disabled -- is being scrutinized by not only the budget panels of the House and Senate, but also a strategic and economic planning committee. 

While Medicaid Reform is just a pilot project in Broward, Duval and three smaller counties, with 255,601 enrolled as of Jan. 1, it has dominated much of the current health-care debate in Tallahassee. The reason is less about the managed care experiment itself than about the sweeping Medicaid “1115” waiver that makes the program possible.

Tucked into the waiver is a health care financing program called the Low Income Pool, or LIP. Under LIP, Florida receives $1 billion annually in extra funds to help finance health care in the state. LIP dollars are mostly targeted to hospitals, though they are available for federally qualified health centers, county health departments and even insurance companies. 

Medicaid Deputy Secretary Roberta Bradford told a Senate spending panel that if the LIP program were to expire, Florida could lose more than $360 million a year. The Florida Hospital Association therefore wants to see the waiver extended. 

The waiver, requested by former Gov. Jeb Bush and granted by the Centers for Medicare and Medicaid Services, expires next year.  Florida can ask for an extension of three years to the program as it currently exists. If the state wants to expand or alter the waiver, though, it would require another approval, which could be a lengthy process. The request would need to be submitted by June 30 of this year. 

The five year pilot project requires most Medicaid patients living in Broward, Duval, Baker, Nassau and Clay counties to enroll in network-style managed care, either an HMO or a provider sponsored network operated by a hospital or group of doctors. 

Under the reform program, managed care plans can treat Medicaid recipients the same way they do other enrollees and alter benefits to meet their needs. In traditional Medicaid, the benefits are defined by the government.

The project has been controversial, in part because it imposes a dollar cap on coverage that does not exist in traditional Medicaid.

Preliminary studies show that the program has saved the state money, but don’t show whether patients are receiving all that they need. Some have criticized the Agency for Health Care Administration for not publishing data that would show which services patients are receiving. 

Social service advocate Karen Woodall fears that the Medicaid HMOs are inspired by profits and skimp on care. Until taxpayers can see the data, she said, the program shouldn’t be expanded.