As the 2011 Florida legislative session entered its final hours on May 6, the two chambers reached compromise language on two bills that significantly remake the state's Medicaid program.
The discussions and subsequent legislation centered on the expansion of a pilot program initiated in 2006 by then-Gov. Jeb Bush that moved thousands of Medicaid recipients into managed care plans controlled by private insurance companies or medical provider networks. Since its inception, the project has been restricted to five of Florida's 67 counties: Baker, Clay, Duval, Nassau, and Broward.
Some lawmakers wanted to take the program statewide, claiming it would save tax payers $1.1 billion in 2012 while improving patient care. Opponents—primarily Democrats—questioned the tax savings and expressed concern about moving some 3 million people into the new program. Rep. Charles Chestnut, D-Gainesville, was outspoken, saying, "This sucks," after listing problems he saw with the two bills.
The proposal splits the state into 11 regions and allows managed care companies to compete for business with the districts. Savings presumably will come from shifting Medicaid from its current fee-for-service program to a plan that caps payments to providers.
The House passed the bills (HB 7107 and HB 7109) by votes of 79-39 and 80-39 after the Senate voted 28-11 and 26-12 to approve them.
The bills now go to Gov. Rick Scott, who is widely expected to sign them. However, even with his signature, the legislation faces another hurdle.
Must Get Federal Approval
Medicaid provides medical coverage to low income individuals and families. In Florida, it covers nearly 3 million people (including almost 27 percent of the state's children) and costs about $20 billion annually. Its services are administered by Florida's Agency for Health Care Administration, but because costs are shared by the state and the federal government, modifications to the program require approval from the federal Centers for Medicare and Medicaid Services (CMS).
The Bush-era pilot program is set to expire on June 30, 2011. In anticipation of that, CMS and Florida have been exchanging letters. CMS has been seeking details on extending the waiver and the expansion plan, and Florida has been stating it is in compliance. A Jan. 31 letter from Scott to Health and Human Services Secretary Kathleen Sebelius said, "The State believes that it met the requirements for 115(e) as CMS approved the waiver as a statewide waiver, with authorization to expand, as approved by the Florida Legislature." The letter closed with a request for the secretary's assistance "in expediting our request."
CMS continues to ask for more detail, and if it does not like what it reads in the new proposal (for instance, the plan needs federal approval to require participants to pay a $10 a month premium and to impose a $100 co-payment for non-emergency care in hospital emergency rooms), it could deny both the state's expansion plan and a continued waiver.
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