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Put Medicaid Reform To The Test

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The Tampa Tribune

Published: November 6, 2007

When the last state administration rolled out a Medicaid reform plan in 2005, proponents painted a bright picture of choice, quality and cost containment. As the Tribune noted ("Weakness in Medicaid Reform Portends No Expansion," Our Opinion, Oct. 28), the bright claims now ring hollow.

No less than the inspector general of the agency charged with implementing the experimental reform says that there is too little data to support claims of quality improvement in Medicaid health care services and that there are other serious problems that need to be resolved.

Her recommendation: Proceed with caution, and do not expand the program until the claims are proven true. Florida legislators should heed this warning in upcoming 2008 legislative session.

The agency inspector general's report was not the first warning sign. A study by Georgetown University earlier this year indicated that doctors and other health care providers had serious difficulty wading through the managed-care bureaucracy for the reform plan so they could care for Medicaid patients. Patients complained they couldn't get information about which plans provided the care they needed. Some physicians simply couldn't afford to provide care to Medicaid patients under the reform plan.

The inspector general's report also cast into question the most glittering claim for the initiative, i.e., that it would contain Medicaid costs. The inspector general's report shows there is still no hard data to support the proposition that Medicaid costs for patients in the reform's pilot programs have been or will be contained. Lawmakers should consider this point carefully in 2008, when a tightening state budget picture may lead some to call for expansion of the managed-care plan as a budget fix.

AARP and others voiced concerns about the Medicaid reform initiative from the beginning. Medicaid reform must deliver more than promises. Wisely, legislative leaders chose to test Medicaid reform's promises with real-world tests. To date, the two pilot programs in Broward and four Northeast Florida counties that are testing managed-care reforms for health care services to children and their families have produced problematic results.

Florida taxpayers should demand that valid data be collected in the Medicaid reform pilots. Lawmakers should require that state officials show them two full years of experience, and independent evaluation of the merits and problems encountered from each of the pilot areas, before the Legislature contemplates expansion of Medicaid reform.

Bold leaders attract the applause of the moment. However, wise leaders will demand that this reform plan proves its claims before they expand it. Frail, vulnerable Floridians deserve no less.

Lori Parham is Florida state director of AARP.

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