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House Medicaid overhaul is on a roll

A House health committee overwhelmingly approved Thursday a plan that would shift hundreds of thousands of Medicaid beneficiaries into HMOs and other managed-care plans, as Republican leaders rush to rein in the roughly $20 billion program.

Part of the bill also changed the way the $1-billion-a-year Low Income Pool – which pays for the care of poor and uninsured patients –is divvied up among hospitals.

The 12-6 vote by the House Health and Human Services Committee was the first move in what likely will be weeks of debate and negotiations about the future shape of Medicaid.

But House and Senate leaders agree the program needs a major overhaul that will rely heavily on managed care.

"There's just no accepting the status quo,'' said Rep. Matt Hudson, a Naples Republican who voted for the bill and also is the House's chief health-budget writer. "We can't be there anymore.''

But Democrats on the committee opposed the bill, with Rep. Mark Pafford of West Palm Beach questioning whether lawmakers were focusing enough on the quality of care that Medicaid beneficiaries will receive.

"The thing that is driving all of this is money,'' Pafford said.

Before Thursday's meeting, committee Chairman Rob Schenck, R-Spring Hill, made several changes to an earlier version of the bill, including the formula for the Low Income Pool.

Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, told the committee that the revision could jeopardize as much as $125 million for facilities such as teaching hospitals and children's hospitals. The revision would make more money available to community hospitals.

The committee, rejected additional changes that Pafford proposed during the meeting. As an example, the Democrat proposed pushing back a deadline for implementing a managed-care system for seniors who need long-term care.

The bill calls for that move to be made by Oct. 1, 2013, but Pafford sought to delay it until October 2014. Schenck, however, said it is important to move earlier because of the large costs in the long-term care program and because managed care can provide services that will help keep seniors out of nursing homes.

With backing from top House leaders, the bill is almost certain to pass the full House in the coming weeks. But that is only part of the equation for overhauling Medicaid, with House and Senate leaders needing to reach agreement on a final plan. Ultimately they’ll need federal approval.

So far, the House and Senate Medicaid-reform bills are substantially different. Among other things, they disagree about how to break the state into regions and how to hold HMOs and other types of plans accountable for serving beneficiaries.

Senate Health and Human Services Appropriations Chairman Joe Negron, R-Stuart, said Wednesday that House and Senate officials have been holding informal discussions about bridging their differences.

And bottom line, Republican leaders agree they need to change the Medicaid system to limit its steadily increasing costs.

"There are differences, but I think the overall goal is the same --- to bring budget predictability to Medicaid,'' said Negron, the chief architect of a Senate proposal released last month but yet to face a committee vote.