Medicaid's most vulnerable need protection, experts find
Published: Friday, October 11, 2013 at 2:51 p.m.
Last Modified: Friday, October 11, 2013 at 2:51 p.m.
Florida’s most vulnerable Medicaid patients are about to be moved into commercial HMOs as part of the last leg of the state’s Medicaid reform that began nearly a decade ago.
As this unfolds, Georgetown University researchers who have been studying Florida’s Medicaid program say that the process will require careful monitoring to ensure patient protections.
Their report, titled “Medicaid Managed Care in Florida: Federal Waiver Approval and Implementation,” which is sponsored by the Winter Park Health Foundation and the Jessie Ball duPont Fund, was released Tuesday.
The authors, Joan Alker and Jack Hoadley, both from Georgetown’s Health Policy Institute, point out that the majority of Florida’s healthiest Medicaid patients have already enrolled in HMOs, leaving the sickest and often the oldest to do so now.
“Because these populations have higher health care needs, they tend to be more expensive and thus are sometimes targets for cost-cutting,” the authors wrote, adding that providing high-quality care for these patients may come into conflict with the need for commercial plans to control costs and generate profits.
“I think the biggest concern is that people now in the program are going to have some changes in how to get coverage,” Hoadley said.
He added that patients may find themselves in a position where one of their prescriptions is no longer covered, or one of their doctors is not in the HMO.
Federal officials granted Florida’s request for a waiver in 2005. At that time, the state launched a five-year pilot program in Duval and Broward counties that later extended to Baker, Clay and Nassau counties.
“Some of the things we noted in the first year or two were some physicians participating in Medicaid were not signed up with the managed care plans, so we had concerns about a reduction in physicians available to see these patients,” Hoadley said.
He added, “We think there was some improvement after the first year. Whether the program saved money or not — we don’t know.”
In June, the Centers for Medicare and Medicaid Services (CMS) granted Florida approval to extend the program throughout the whole state. Implementation could begin on April 1, 2014. Patients who don’t enroll will be automatically enrolled.
Hoadley said one of the most important consumer protections in the new waiver is that managed-care companies must spend at least 85 percent of premium dollars on medical services (not overhead). Florida officials also will have to report to federal officials on a quarterly and annual basis.
“There is a pretty good set of conditions in place,” Hoadley said. “The ongoing issue is making sure that these things really happen. Have patients been able to find docs they need? Are the various stakeholders doing their jobs? It’s up to both the state and federal government and outside observers” to monitor.
Hoadley added that this latest Medicaid reform does not have anything directly to do with Florida’s decision not to expand Medicaid coverage.
“If they do choose to expand, we would expect the state to bring in any expansion populations under the terms of this waiver,” he said.
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