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Florida's Medicaid Reform Plan In Danger Of Failing

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The Tampa Tribune

Published: October 27, 2008

Gov. Jeb Bush sold his "Medicaid Reform" plan by convincing lawmakers the managed care program would make it easier for patients to receive care while allowing the state to better control Medicaid's budget.

But two studies in the last year have concluded there's not enough data from the five-county pilot project to prove Bush right, while anecdotal evidence suggests the reform hasn't worked as the former governor had hoped.

And now, even as the Agency for Health Care Administration has requested an increase in its budget to expand the program to 20 more counties, three health care companies that cover 60 percent of the patients enrolled in the pilot plan, including Wellcare Health Plans Inc., of Tampa, have told the state they want to pull out of it.

So the end-result is that this bold project that once seemed to hold such great promise may well be shut down.

Having injected a new level of bureaucracy and a profit motive into the health care system, the state cannot show the program has served taxpayers or patients very well. Rather, the companies seem to have made money by saying no to doctors and limiting services to patients.

Bush's reform envisioned private companies managing patient care and saving money. He believed that by introducing greater competition to the marketplace, the state could better control the rate of growth in Medicaid spending and save taxpayers millions.

Here's how it was supposed to work: The companies would receive premiums from the state for providing medical and health benefits to the poor and elderly. A minimum percentage of those premium payments was supposed to be spent on care and if not, the remainder returned to the state.

But companies like WellCare didn't play fair. The company acknowledged last summer that it had understated the amount of refunds it owes state governments nationwide by $49 million.

And earlier this month Federal authorities detailed what they call a scheme by the company to defraud Florida's health agencies of more than $20 million.

In essence, the experiment at this moment seems to be failing. The companies appear purely profit driven.

Then, in the midst of the economic slowdown that has cost Florida billions in tax revenues, the state cut Medicaid payments by five percent, guaranteeing lower revenues, a prospect the for-profit providers won't abide.

They represent fat; they don't provide value to patients and taxpayers.

This is borne out by studies from Medicaid's former inspector general and the Georgetown University Health Policy Institute.

While neither study would draw conclusions about success or failure, they document the complaints of doctors hassled by paperwork who believe they are not adequately reimbursed. Physicians also complained the reform makes it too difficult to refer patients to specialists, thus raising questions about patients access to needed care.

As for patients, some have complained the program is too complicated and they can't figure out their coverage.

The inspector general's report found serious problems with the program and recommended delaying expansion. Because of coverage limits, some patients with chronic illnesses said they could not obtain the medicine they needed. Others had a difficult time choosing a plan because of errors on physician and medication lists.

While the state must not abandon efforts to curb Medicaid spending, Bush's reforms don't look to be a solution.

Lawmakers shouldn't even think about expanding the program until they have asked a lot more questions.

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