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Senators’ Medicaid changes to be unveiled next week

Florida Senate leaders next week will release their first detailed proposal for overhauling the Medicaid system, calling for a shift of hundreds of thousands of beneficiaries to managed-care plans.

Senate Health and Human Services Appropriations Chairman Joe Negron, R-Stuart, said this morning he will release a bill next Thursday about how to re-make the $20 billion program. Designed to cover low-income children, the elderly and disabled, Medicaid has been a lightning rod during budget discussions because of its growth in bad economic times.

Negron said Senate President Mike Haridopolos, R-Merritt Island, has scheduled a special meeting Tuesday on the Senate floor to discuss ideas for changing the system.

Negron said the bill remains a "work in progress.''

"We started literally with a blank sheet of paper, and we tried to construct a new Medicaid program that transforms the way we provide care to our fellow citizens,'' he said.

Meanwhile, aides to Gov. Rick Scott said he will not propose a detailed Medicaid overhaul but will work with the House and Senate to agree on a plan. Like Republican legislative leaders, Scott backs a major shift to managed care to help hold down spiraling costs in the program.

Scott released a budget proposal this week that says the state could save $1.2 billion during the 2012-13 fiscal year by revamping Medicaid. Such savings would not be possible during the upcoming 2011-12 year because of time it would take to put the mandatory managed-care system in place.

But Negron said he expects to propose a budget during the upcoming legislative session that will cut overall Medicaid spending, at least in part through the program overhaul.

"Our goal is to achieve immediate savings,'' he said.

Florida is not alone in looking to use managed care to help solve Medicaid budget problems --- other states are considering such moves or have already made them. But many patient advocates and health-provider groups are worried that the overhaul could lead to reduced services for Medicaid beneficiaries.

Two controversial issues during the Medicaid debate will focus on whether a managed-care requirement should apply to people with developmental disabilities such as Down syndrome and to seniors who need long-term care. Jane Johnson, a health-budget aide to Scott, told Negron's committee this morning the governor backs including those groups, though indicated it could take time.

"I think eventually, he would like to see all the Medicaid programs wrapped up in that umbrella,'' Johnson said.

As Scott and lawmakers get ready to revamp Medicaid, a major unknown is whether the federal government will go along with the state's plans. Federal officials last year declined to grant Florida a straight extension of a five-county Medicaid pilot program that began in 2006, leading to talks that remain ongoing.

That pilot program requires most beneficiaries in Broward, Duval, Nassau, Clay and Baker counties to use HMOs or other types of managed-care plans.

The Senate last year backed expanding the pilot program to 19 additional counties. But senators did not develop a detailed plan to make those changes --- or to go further.

The House, meanwhile, approved a comprehensive bill last year to gradually shift virtually all Medicaid beneficiaries into managed care. House leaders have already said they will use that bill --- which the Senate did not approve --- as a starting point for Medicaid discussions during the upcoming 2011 legislative session.

Exact details of the Senate draft bill remain unknown. But broadly, Negron and Haridopolos have already made clear they will propose a statewide managed-care system.

Legislative leaders also have been looking at the possibility of trying to shield doctors who serve Medicaid patients from costly lawsuits. Negron said such an idea will be included in the Senate bill, though details need to be worked out.

That likely will touch off a controversy, with trial lawyers arguing that lawsuit limits shouldn't be imposed on patients injured by malpractice just become they can't afford private coverage.

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