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Give State Medicaid Reform Plan A Chance

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By BILL GALVANO

Special to the Tribune

Published: December 6, 2008

I am writing in response to the editorial published by this newspaper Oct. 27 regarding the Medicaid Reform plan. It is important that certain points you raised are answered and clarified.

Florida's Medicaid Reform project is still in its infancy, having just completed its second of five years, and many aspects of the program have been a success.

While some studies have been critical, others, such as the report published by the James Madison Institute entitled "An Evaluation of the Pilot Project to Reform Florida's Medicaid Program," have concluded that "Florida's pilot project not only ought to be continued in the places where is it already underway" but also that "the reforms instituted under this pilot project ought to be extended to the remainder of the state."

This study goes further and actually criticizes the Georgetown study cited by the editorial, and questions the validity of that study because of its tiny population size of 80 beneficiaries who were interviewed. Another study conducted by the University of Florida is due to be published soon, and I trust it will provide further insight into the successes, and areas for improvement, of the Medicaid Reform project.

Additionally, the request by the Agency for Health Care Administration for budget authority to expand the program is an exercise on paper only. It does not mean the agency is pushing for expansion. In fact, the agency requested the same thing last year, and the purpose of this is to serve as a place holder should the Legislature decide to expand reform.

But only the Legislature can make that decision, and the agency is just preparing itself just in case.

Further, the editorial's description of how reform is supposed to work and how WellCare Health Plan didn't play fair is not accurate and out of context. It appears to be a reference to what is commonly known in the managed care world as the "80/20" rule, whereby if a managed care plan expends less than 80 percent of their annual capitation for the provision of behavioral health care services, the difference must be returned to the agency.

WellCare indeed admitted it had understated how much of this refund it owed the agency. But these 80/20 issues do not occur in nor do they apply to Medicaid Reform counties, and thus the editorial's argument on this matter doesn't fit.

Plus, WellCare decided not to leave the reform pilot, and the other health plans that did leave only served about 8 percent of the beneficiaries. Eight plans remain with plenty of capacity for those beneficiaries.
Medicaid Reform is a pilot project, and with pilots come successes and failures.

But in order to fully understand what is working and what is not, evaluators cannot, as the Tampa Tribune editorial did, pick and choose what evidence they want to examine. A true evaluation of a pilot comes from examining all the evidence, and only the evidence that actually pertains to the pilot.

Bill Galvano of Bradenton represents District 68 in the Florida House of Representatives.

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