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House passes Medicaid overhaul

By Jim Saunders
4/19/2010 Health News Florida

Calling the current system "broken'' and warning of long-term financial problems, the state House today approved a proposal that would gradually shift almost all Medicaid recipients into managed-care plans.

The votes on two bills set the stage for the House and Senate to try to reach agreement on a Medicaid overhaul before the annual legislative session ends April 30. The Senate has passed a different Medicaid managed-care bill that would expand a five-county pilot program to 19 additional counties.

In a last-minute change today, the House delayed until 2012 a requirement that managed-care recipients in Miami-Dade County enroll in managed-care plans --- after earlier setting a June 30, 2011, deadline. House leaders planned to expand the pilot program into Miami-Dade as the first step in a five-year process of requiring managed care.

The change, approved with almost no discussion, would start phasing in the Miami-Dade requirement Jan. 1, 2012, with a final deadline of Oct. 1, 2012. Such a change appears to eliminate any cost savings that the state could receive during the 2010-11 fiscal year from putting Miami-Dade recipients in managed-care plans.

House members voted 80-34 and 83-32 to approve the two related bills that would lead to a statewide Medicaid managed-care system. Supporters of the House bill said many recipients do not receive quality care currently and that spiraling Medicaid costs pose a major problem for the state.

"We cannot continue to do things the same way over and over again and expect different results,'' Rep. Matt Hudson, R-Naples, said during a debate on the House floor.

But opponents said Republican leaders had jammed through the proposal without adequate consideration from health-care committees. They also warned that requiring enrollment in managed-care plans would be disruptive to "vulnerable" Medicaid recipients, who are low-income and, often, elderly or disabled.

"Right now, this bill is completely flawed, and it is a disservice to our folks who are living, in some cases, in their last stages,'' said Rep. Mark Pafford, D-West Palm Beach.

With less than two weeks left in the legislative session, it is not clear how --- or if --- the House and Senate will bridge their differences about overhauling Medicaid. Senate Health Regulation Committee Chairman Don Gaetz, R-Niceville, said today he expects House and Senate officials to meet this week to discuss the House proposal.

"It is late in the session, but process should not trump product,'' Gaetz said.

But Rep. Ron Saunders, a Key West Democrat who voted against the House proposal, said he did not expect the Senate to go along with the House proposal because it is coming up so late in the legislative session.

"The Senate is not going to take it up, in my opinion,'' said Saunders, who is slated to become House Democratic leader after the November elections.

With Medicaid expected to cost more than $19 billion during the fiscal year that starts July 1, legislative leaders hope that increased use of managed care will help rein in the program.

The already-existing pilot requires managed care for most recipients in Broward, Duval, Nassau, Baker and Clay counties. The Senate plan to expand that program would include major metro areas, such as Miami, Orlando, Tampa and St. Petersburg.

The House proposal, meanwhile, would carve the state into six geographic regions and gradually require managed-care enrollment for different Medicaid groups. That includes seniors who need long-term care and people with developmental disabilities.

Winter Park Republican Dean Cannon, who is one of the architects of the House proposal, said changes are needed because the current Medicaid system is "broken.''

But Orlando Democrat Geraldine Thompson said the state should not move Medicaid recipients into HMOs where they will be "treated as numbers rather than as individuals.''

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at