Five years after a controversial pilot program began in Broward and Duval counties, the Florida House on Thursday approved a statewide proposal to shift Medicaid beneficiaries into managed-care plans.
The Republican-dominated House voted 80-38 along almost straight party lines to approve a bill that details a five-year process for overhauling the Medicaid program. Another bill needed to carry out the changes passed 78-39.
Supporters said the plan would improve care for Medicaid beneficiaries, reduce widespread fraud and control costs in the $20 billion program.
"This bill is about reform,'' said Health Appropriations Chairman Matt Hudson, R-Naples. "This bill is about taking a look at where we are today and asking a very simple question: Are you satisfied with the status quo?''
But Democrats said the plan would be a boon to for-profit HMOs, which likely would receive contracts to manage care for hundreds of thousands of beneficiaries.
"This is a giveaway of $20 billion to folks that work out of the sunshine, because we're going to ask somebody else to deal with our poor Floridians,'' said Rep. Mark Pafford, D-West Palm Beach.
Opponents also questioned the move to a statewide managed-care system, because they said the pilot has been unpopular in Broward County. Along with Broward and Duval, the pilot now operates in Baker, Clay and Nassau counties.
"Not once have I ever heard anyone involved in this pilot program in Broward County say they liked it, it was good for them or it was quality health care,'' said Rep. Evan Jenne, a Democrat from the Broward town of Dania Beach.
But bill sponsor Rob Schenck, R-Spring Hill, and House Speaker Dean Cannon, R-Winter Park, said the plan includes major differences from the pilot program. For example, HMOs and other types of managed-care plans would have to compete for contracts in eight different regions of the state, which could help hold them accountable for performing well.
Also, the plan includes financial penalties if HMOs pull out of the program before the end of their five-year contracts. Critics say HMOs withdrawals from pilot counties have caused turmoil for patients.
Revamping Medicaid is one of the biggest issues of this year's legislative session, with House and Senate leaders and Gov. Rick Scott backing a shift to managed care. A bill also is moving through the Senate, though it includes some key differences from the House measure.
House and Senate negotiators will have to reach agreement on a final plan in the coming weeks. It also would need federal approval.
The House measure would gradually require different groups of beneficiaries to enroll in managed-care plans. The process would start in July 2012 with seniors who need long-term care, before moving in January 2013 to a broader group of beneficiaries such as women and children.
People with developmental disabilities --- such as cerebral palsy and mental retardation --- would start enrolling in January 2015. Each of the groups would have more than a year to fully enroll, with a final deadline of Oct. 1, 2016, for people with developmental disabilities.
Along with HMOs, the other types of managed-care plans in the program likely would be provider-service networks. Those locally based networks could be centered at hospitals or other types of providers, such as federally qualified health centers.
Republican and Democratic lawmakers Thursday agreed the Medicaid program needs changes, but split about whether mandatory managed care should be the answer.
Supporters said one benefit of managed care is that it would help curb fraud that has bedeviled the program in areas such as South Florida. HMOs and other plans would get paid set amounts of money to care for each beneficiary, so they would have an incentive to avoid paying fraudulent bills from providers.
"You know what people in my part of the state don't like doing? They don't like subsidizing fraud elsewhere,'' said Panhandle Rep. Matt Gaetz, R-Fort Walton Beach.
But Rep. Franklin Sands, D-Weston, questioned how the state would make sure the managed-care plans operate properly. He said some Broward patients in the pilot have faced delays or have not received services.
"The state has a very poor record of oversight, and we're going to be giving $20 billion to private companies,'' said Sands, who represents a large part of western Broward.
--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at jim.saunders@healthnewsflorida.org.