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It’s the end of the Tom Arnold era

By Jim Saunders
9/1/2010 © Health News Florida

Tom Arnold spent part of his last day at the Florida Agency for Health Care Administration talking about the Medicaid "reform" pilot and potential budget cuts. With or without Arnold, some things presumably will never change.

But later Tuesday afternoon, Arnold rolled a cart into AHCA headquarters and said he was "getting into the loading.'' Retiring as AHCA secretary after 31 years in state government, Arnold said he doesn't know what he will do next.

"No plans yet,'' he said.

Elizabeth Dudek, a longtime AHCA official who most recently worked as deputy secretary for the Division of Health Quality Assurance, will serve as interim secretary until a new governor takes office after the November elections.

Arnold, who survived a confirmation fight this spring in the Florida Senate, has said little publicly about his reasons for retiring --- or whether he will stay retired. He is one of the most-knowledgable people in the state about the $20 billion Medicaid program, serving earlier in his career as Medicaid director.

During a meeting Tuesday of the Medical Care Advisory Committee, a panel that monitors the Medicaid program, Arnold said he told his wife in the past that his career goal was to go out as an agency head.

"It's been (a) very rewarding time for me,'' Arnold said.

Committee member Jennifer Lange, a Florida Department of Children and Families official who oversees Medicaid eligibility, praised Arnold's knowledge. While AHCA is in charge of Medicaid services, the Department of Children and Families determines whether people are eligible for the program.

"We always felt comfortable that he gets it (the eligibility system),'' Lange said.

As Arnold leaves and Dudek takes over, however, AHCA faces major unresolved issues. One of the biggest is trying to get federal approval of a three-year continuation of the Medicaid reform pilot.

That program, a top priority of former Gov. Jeb Bush, requires most beneficiaries in five counties to enroll in managed-care plans. It started in 2006 and is scheduled to expire June 30, 2011.

The federal Centers for Medicare & Medicaid Services sent a letter to the state Aug. 17 indicating it will seek changes in the program. Federal officials also didn't go along with an AHCA request to make a decision within six months on extending the program --- which raises questions about whether a decision will be made before lawmakers begin their annual session in March.

Phil Williams, AHCA's assistant deputy secretary for Medicaid finance, said state and federal officials will meet Sept. 23 to discuss the waiver. He said the Aug. 17 letter "did not come as a surprise'' because of earlier conversations between officials from AHCA and the federal government.

Arnold, who has supported moving more Medicaid beneficiaries into managed-care plans, tried to tamp down speculation that the controversial reform program could be in jeopardy. He also said federal officials "understand the time frames" about trying to get the waiver resolved before the legislative session.

"None of the conversations that we've had with the federal government have indicated concerns about whether this waiver will be renewed or not,'' he told the committee.

While AHCA deals with the Medicaid reform questions, Williams said Tuesday that tough budget times also are forcing the agency to look for possible cuts of up to 15 percent for the 2011-12 fiscal year.

Similar budget exercises in the past have not led to such drastic cuts. A 15 percent cut would total about $950 million in state funding, plus a loss of more than $1 billion in federal matching funds.

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at jim.saunders@healthnewsflorida.org.