House panel OKs letting private companies manage those on Medicaid

A House panel voted overwhelmingly on Monday to let private companies manage the care of nearly all of Florida's 2.7 million Medicaid beneficiaries.

Some groups warn, however, that a one-size-fits-all approach could harm people with special needs.

The expedited bill cleared its only House committee stop on a vote of 16-1 and hits the chamber floor next.

The plan's architects, Republican Reps. Denise Grimsley and Dean Cannon, say they want to eliminate the "patchwork" system of carve-outs and exemptions that make up Florida Medicaid -- a $19-billion program expected to grow to $28 billion by 2014-2015.

Their proposal would gradually double the number of Medicaid beneficiaries whose care is overseen by a private company or organization --- including, for the first time, seniors in long-term care and people with developmental disabilities.

Exceptions would be made only in rare cases, such as aliens eligible for emergency services. The state would implement the change over five years, with the last phase affecting people with developmental disabilities.

Monday, advocates and care providers warned that such a system may save money, but will not meet the complex needs of that vulnerable population.

That's partly because the majority of services on which they rely are not medical in nature, said Kingsley Ross, representing the Autism Society of Florida. Most are "companion services, adult day training services, supportive employment services, residential habilitation services ... basically training in nature."

Managed-care organizations focus on medical care, a model that has not worked well for people with such disabilities, he said.

Dixie Sansom, of the ARC of Florida, agreed. "Most of ... the citizens of Florida with developmental disabilities, they are not going to fit into [that] square hole," she said. "They are not in nursing homes; they are not in hospitals."

People with such disabilities struggle with change, said Charles Jackson, an advocate representing the Family Care Council of Florida, and who has autism.

Over the last year, he said, patients, families and providers have worked with the Agency for Persons with Disabilities on a proposal to customize service budgets for people with disabilities based on their needs. By contrast, Jackson said, those with disabilities had little input in the House's bill.

"We were among the last to know of this plan," he said. "We are told that managed care entities will have an advisory board with family and self-advocates on them. What would make them include us in any decision making?"

Cannon, chairman of the House council, acknowledged the intricacies of caring for people with special needs -- which is why, he said, his panel delayed full implementation until 2015.

"The fact that they have unique needs doesn't mean that they can't be well managed and properly managed," said Cannon, R-Winter Park.

The House plan, he noted, protects patients by paying more to plans managing beneficiaries who need more care and requiring all plans to spend 80 to 85 percent of their premium on patient care.

The Senate's plan would expand an existing managed-care pilot project to 19 counties and does not mandate managed care for people with developmental disabilities or seniors in long-term care.

Senate health care budget chief Durell Peaden was skeptical about the House version. The state, he said, needs more data on the still-controversial pilot project before transferring virtually all beneficiaries to privately managed care.

A Senate panel has scheduled five hours of discussion -- but no vote -- on Wednesday about the House proposal. Legislative leaders say the bill is headed for conference negotiations.