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Q&A: House, Senate differ on Medicaid overhaul

The Florida House and Senate agree that Medicaid should be revamped, but they have vastly different views of how it should be done.

Here are some of the key questions they need to answer:

--- Who should be included in managed care? Both the House and Senate would enroll the vast bulk of Medicaid beneficiaries, such as children and women, and seniors who need long-term care.

But the chambers disagree about whether thousands of people with developmental disabilities, such as autism and mental retardation, should be required to enroll in managed care. The House wants to include that group, while the Senate would not.

--- How should the state be carved up for a managed-care system? Under the House and Senate proposals, managed-care companies would compete for Medicaid contracts in different regions of the state.

The House wants to carve the state into seven regions, while the Senate favors 19 smaller regions. The answer to this question is important, at least in part, because regions have to include enough Medicaid beneficiaries to make them financially viable for managed-care plans. Hospitals that are forming networks to compete with HMOs have favored smaller districts that comprise their referral areas.

--- How would managed care be phased in? The Senate wants to move much faster than the House, proposing that the statewide managed-care system would be in place for most beneficiaries by Dec. 31, 2012. For long-term care, the deadline would be March 31, 2013.

The House, meanwhile, would start with long-term care being fully implemented by Oct. 1, 2013. For the broader Medicaid population, the target date would be Oct. 1, 2014. For people with developmental disabilities, it would be Oct. 1, 2016.

--- How would managed-care plans be held accountable? The House and Senate both would require managed-care plans to sign five-year contracts but would take different approaches to ensuring that the system provides quality care.

One of the issues, for example, centers on making sure HMOs and other plans spend enough money on patient care.

The Senate would require plans to spend 90 percent of the money they receive on care -- a concept known in the insurance industry as a "medical loss ratio.'' The House, meanwhile, would use a profit-sharing formula that would require plans to send money to the state if they make more than 5 percent in profits.

--- What happens with the federal government? Clouding the whole Medicaid issue is that Florida needs approval from the federal government to make major changes.

The Senate proposal takes a confrontational approach to the issue, threatening to forgo billions of dollars in federal funds if Washington doesn't go along with the state's wishes. Such a move would allow Florida to craft its own Medicaid program without federal restrictions.

But the House proposal makes no such threats, with House Speaker Dean Cannon, R-Winter Park, expressing doubts about the wisdom of such a strategy.

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