Medicaid med-mal limits okayed
Florida lawmakers moved Thursday toward placing new limits on medical-malpractice lawsuits involving Medicaid patients, arguing the move could help draw more doctors into the program.
The House Appropriations Committee approved a Medicaid bill that would limit non-economic damages --- which are awarded for such things as pain and suffering --- to $300,000 in cases where doctors or other providers are at fault for injuries to Medicaid patients.
A Senate bill already included a similar limit. In both chambers, the malpractice limits are parts of wide-ranging bills aimed at overhauling the Medicaid system.
"There clearly is an interest in the tort (liability) aspects of Medicaid,'' said Sen. John Thrasher, a St. Augustine Republican who has long been involved in efforts to limit lawsuits against doctors and hospitals.
But Orlando personal-injury attorney Maria Tejedor appeared before the House Appropriations Committee and criticized the idea of capping the amounts low-income Medicaid beneficiaries could receive in lawsuits.
"It creates two doors to the courthouse, one for the haves and one for the have-nots,'' she said.
Tejedor said malpractice lawsuits also can help recoup money for the state when a Medicaid patient needs treatment for catastrophic injuries. She said the proposed limits could prevent lawyers from being willing to represent Medicaid patients in malpractice cases. That, in turn, could reduce the amount of money that could go back to the state.
But Rep. Rob Schenck, a Spring Hill Republican who is sponsoring the Medicaid bill, disputed that. He said so-called "economic" damages --- which are awarded for such things as lost wages --- would not be limited under the bill and could be used to pay back Medicaid.
The lawsuit limits were one of the most heavily debated issues as the Appropriations Committee approved two bills that make up its plan to overhaul the Medicaid system.
The committee voted 12-8 to approve House Bill 7107 and 15-8 to approve House Bill 7109.
Both votes were along party lines, with Republicans supporting the measures and Democrats dissenting.
Under the bills, Medicaid would gradually move to a system in which almost all beneficiaries are enrolled in HMOs or other types of managed-care plans. Supporters contend that such a system would help control the steadily increasing costs of the $20 billion program, but other groups are worried about turning the system over to managed care.
Senate President Mike Haridopolos, R-Merritt Island, acknowledged that limiting lawsuits might help gain support from doctors and hospitals.
"We're hopeful that we can craft a plan that's not going to make everybody happy but also (would) give some sweeteners to try to get people to buy into a reform package as necessary,'' he said.
The Appropriations Committee on Thursday added the lawsuit limits to one of the bills and made several other changes to its Medicaid plan. As an example, the committee tinkered with a formula used to distribute money to hospitals through the so-called Low Income Pool --- which helps pay for the care of poor and uninsured people.
Compared to an earlier version of the bill, the change would send more money to teaching, rural and children's hospitals and reduce the amount going to community hospitals.
The committee, meanwhile, rejected a Democratic proposal that would have set guidelines for how much money HMOs would be required to spend on patient care. The proposal would have required that 80 to 85 percent of the money HMOs go to services --- what is known as a "medical loss ratio.''
"The medical-loss ratio is a way to really gauge how much is actually going to the care that these folks need,'' Anne Swerlick, an attorney for Florida Legal Services, told the committee.
But Schenck said the ratio would be "redundant" because the bill already includes a profit-sharing requirement. That requirement would force Medicaid HMOs to send money back to the state if they make more than 5 percent profits.
Supporters of overhauling Medicaid contend that the current system is hobbled by a lack of doctors who are willing to participate. A major part of the problem stems from low payment rates, but lawmakers hope that shielding doctors from costly lawsuits filed by Medicaid patients also would help.
Under the House bill, total non-economic damages would be capped at $300,000 when more than one medical provider is at fault for injuries to a Medicaid patient. No single provider would be liable for more than $200,000.
Typically, state law limits non-economic damages in malpractice cases to $500,000, though that total can differ depending on circumstances of a case.