Medicaid change goes to vote today

Lawmakers today will consider a massive overhaul of Medicaid, Florida's health care safety-net for 3 million poor and disabled residents, that would turn over their care to HMOs and other managed-care organizations.

Weeks of closed-door negotiations between the House and Senate yielded a deal that finally emerged Thursday, the Legislature's next-to-last day of its session.

Republican leaders in both chambers have argued loudly for the past year that Medicaid, a $20 billion state-federal program, is consuming too much state money, and agreed broadly on transferring most of Florida's Medicaid beneficiaries into private managed care.

Senate sponsor Joe Negron argued this will lift the stigma from beneficiaries of Medicaid, in which many doctors do not participate because of low reimbursement rates and paperwork headaches.

The overhaul, he said, means that Medicaid beneficiaries will be served by the same kinds of managed-care entities that handle the care of wealthier residents who pay for their own coverage. The legislation also offers incentives to the managed-care plans to increase reimbursement rates for primary care physicians, though it does not require such raises.

"I think it's important that people on Medicaid are treated like first-class citizens," Negron said.

Negron, R-Stuart, defended the process, noting that lawmakers have heard hours of testimony about Medicaid from patients, doctors, insurers and other stakeholders.

"This has been an unbelievably open process," Negron said.

The Senate now is poised to approve the bill and send it to the House for final passage.

The proposed overhaul builds on a privatization experiment championed by former Gov. Jeb Bush. That five-year, five-county pilot program is scheduled to end this summer.

Reports on the managed-care pilot's cost-effectiveness and quality of service have varied widely since the start of the program, which patient advocates and some researchers have criticized as compromising care.

Although they shared a common starting point, the House and Senate differed initially on myriad details — among them, whether Florida should remain in Medicaid if federal regulators reject the Legislature's planned overhaul. The federal government pays more than half of Florida's Medicaid program.

The Senate proposed this year that Florida pull out of Medicaid if the federal government refused to approve the Legislature's plan. House leaders balked, however, and the deal taken up by the Senate on Thursday contained no such provision.

The decision is significant because the U.S. Centers for Medicare and Medicaid Services may indeed object to the plan.

That's because it leaves out a component that federal regulators already are demanding: that the state set a minimum percentage of money that managed-care plans must spend on patient care.

The legislation includes new restrictions on prescribing psychotropic medications for children on Medicaid. That's a particular cause of Sen. Ronda Storms, who has advocated for such restrictions since the death of Gabriel Myers, a 7-year-old foster child who hanged himself in 2009 after being prescribed multiple strong psychotropic drugs. Per the bill, such drugs could not be prescribed without either a court order or parent's consent.

Storms, R-Valrico, argued unsuccessfully to strengthen the proposed restrictions even further: "We are completely overmedicating these children."

Thursday's deal would divide Florida into 11 regions, fewer than the Senate's proposed 19 but more than the House's proposed eight.

The plan phases in the overhaul across several years.

Overhauling Medicaid, a program representing billions of dollars in payments and care, has drawn hospitals, doctors, insurers, patient advocates and many other constituencies into the complex debate.

cwhittenburg@tampatrib.com

(850) 222-8382