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Medicaid pilot hearings begin

By Jim Saunders
5/20/2010 © Health News Florida

A massive overhaul of Florida's Medicaid system is on the shelf --- at least for now. But get ready for three more years of debates over the pilot managed-care program that former Gov. Jeb Bush left behind, with hearings starting Friday. 

The state Agency for Health Care Administration will hold the hearings as a prelude to filing a request with the federal government to continue the controversial program. It currently requires about 260,000 Medicaid recipients in five counties to get care through HMOs or provider-service networks.

AHCA Secretary Tom Arnold said the state won't seek to make changes in the program's original outline, created through a waiver of federal Medicaid rules. But he said he hopes the hearings will offer information on how the program is working.

"I think it's important to get out and ask the people directly, 'What can we do better?' '' Arnold said this week.

But critics of the pilot, such as Greg Mellowe of the advocacy group Florida CHAIN, aren't sure the process of extending the waiver will be so benign. Mellowe said he doesn't rule out the possibility that AHCA will try to make substantive changes in the program.

As federal and state officials discuss an extension in the coming months, he said, it will be important for the federal government to consider issues and viewpoints beyond those of AHCA.

If not, he said, "then nothing that stakeholders say, at these hearings or otherwise, will matter. 

"And based on AHCA`s track record, these hearings are nothing more than an attempt to say that they heard from the public, in the hopes that the feds will simply check off some 'public participation' box on the review checklist,'' Mellowe said in an e-mail Wednesday.

State lawmakers spent much of this spring's legislative session debating possible ways to overhaul the Medicaid system, primarily by moving more beneficiaries into managed-care plans. But the House and Senate did not agree on a plan and, in the end, passed a bill directing AHCA to start the process of seeking an extension of the pilot program. It now operates in Broward, Duval, Baker, Clay and Nassau counties.

AHCA faces a July 1 deadline for submitting an application to the federal government. The original waiver for the program, which was a top priority of Bush, expires June 30, 2011. 

Even if the details of the waiver do not change, the extension process has high stakes. Arnold said, for example, the waiver already allows an expansion of the pilot program to other counties --- which could bolster efforts by future legislative leaders to increase the use of managed care in the Medicaid system.

Also, a waiver extension is critical to many hospitals because it includes the "Low Income Pool," about $1 billion a year in extra funds to care for the uninsured patients. 

Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, said it would be "devastating'' if the Low Income Pool funding ended. While hospitals likely would be able to tap into another program, known as the Upper Payment Limit, Carvalho said it is widely believed they would end up with less money than they receive through the Low Income Pool.

"Is it (the Low Income Pool) important? Yeah. It's a billion dollars for the state,'' Carvalho said.

But the extension --- and any future requirements that more Medicaid beneficiaries enroll in managed-care plans --- will run into criticism. Some advocacy groups have long feared that patients tend to suffer in a managed-care system because HMOs will squeeze benefits to save money.

Also, they argue that beneficiaries in Broward and Duval faced upheaval when HMOs pulled out of the pilot program, forcing people to look for other health plans.

"Our biggest concern is that AHCA will continue to act as if the multitude of problems with the current pilot don`t even exist, let alone have been resolved,'' said Mellowe, the policy director for Florida CHAIN. "We believe that there are reasons to consider extending the waiver, but to do so without fixing the problems is far too risky, especially since expansion would bring those same unresolved problems to the rest of the state.'' 

But supporters of requiring Medicaid patients to enroll in managed care contend that it helps hold down costs in the $19 billion  program. Also, they say it helps combat fraud, which is particularly rampant in South Florida.

The waiver extension would allow the pilot program to continue running until 2014. If necessary, the state could ask for another three-year extension after that, continuing the program until 2017.

The first public hearing will be at 1 p.m. Friday at AHCA headquarters in Tallahassee. That will be followed by a hearing at 1 p.m. June 8 in Jacksonville and at 10 a.m. June 9 in Fort Lauderdale. 

Additional meetings will be held at 2 p.m. June 10 in Yulee; 10 a.m. June 11 in Green Cove Springs: and 2 p.m. June 11 in Macclenny. AHCA has posted more information about the locations of the meetings at this site

As of last month, about 170,000 people in the five counties were enrolled in HMOs as part of the pilot program. An additional 90,000 were enrolled in provider-service networks.

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