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Weaknesses With Medicaid Reform Portend No Expansion

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The Tampa Tribune

Published: October 29, 2007

Across the country states have tried to come up with ways to hold down the cost of Medicaid, and no reform program initially showed greater promise than the Florida effort advanced by Jeb Bush.

The former governor proposed a bold but complicated plan that essentially created a new Medicaid delivery system of private insurers intended to give consumers more choices and, theoretically, improved service.

Bush believed that by introducing greater competition to the marketplace, the state could better control the rate of growth in Medicaid spending, and taxpayers would save millions.

But characteristically, Bush was in a hurry. He wanted the Legislature to implement his plan statewide at once. Lawmakers instead only approved the pilot project currently under way in Broward and Duval counties.

They were wise not to rush.

Now two years into the project, Medicaid's inspector general has found serious problems with the program and recommends delaying any expansion.

In a 74-page report, Linda Keen, inspector general of Florida's Agency for Health Care Administration, said parts of the program were implemented too quickly by too few people.

Some patients have found it more difficult to find doctors or to get information about coverage.

Of major concern to Keen is that there is no data from participating health plans to evaluate the quality of service, accessibility or cost-effectiveness of the reforms. Such information is essential to prove the program's worth.

Bush wanted a program in which the state would buy insurance policies from managed-care organizations competing for low-income patients. The patients, with tutelage from counselors, would choose the HMO or other plan that best suited them.

But the report found because of coverage limits, some patients with chronic illnesses could not obtain the medicine they needed. Others had a difficult time choosing a plan because of errors on physician and medication lists. Some couldn't reach specialists.
Patient advocates praised the findings, which confirmed what they had predicted: The reforms make it difficult for some people to get funding for necessary care.

The reports should not cause the state to abandon its efforts to curb Medicaid spending. Perhaps with some improvements, the reforms will prove effective at both controlling costs and improving health care for the poor.

But it's clear the state has a lot of questions to ask and changes to make before the program can be expanded.

The episode shows that there are times when it's best to go slow when overhauling a government program, particularly one that affects individuals' health.

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