AHCA: Request to expand ‘Reform’ isn’t what it appears

Oct 22, 2008

Florida Health News--October 20, 2008

By Carol Gentry

The Agency for Health Care Administration says its legislative budget request for expansion of the ‘Medicaid Reform’ pilot project into 20 more counties next year isn’t what it appears to be. The request is merely a “placeholder” for future action, AHCA spokesman Fernando Senra said Monday by e-mail.

Because the state has an approved federal waiver that anticipates expansion for the pilot by 2011, AHCA needs to present an estimated cost in case the governor and Legislature want to move forward with it, he said.

“The Agency has not made any recommendations at this time (either way) on this issue,” he said. . “Nothing should be considered final at this point.”

The pilot, which now operates in five counties under a federal waiver of the usual Medicaid rules, requires beneficiaries to enroll in managed care, usually HMOs, that can offer extra benefits but also can cap them. The HMOs are paid more if they enroll sicker beneficiaries and less if they have healthier ones, and the state expects them to assume part of the financial risk.

AHCA sent the legislative budget request, which included a suggested pay increase for specialists who treat Medicaid patients and an increase in fraud-finders, to the governor’s office last week, just after release of a report critical of the Florida experiment by a team at the Georgetown University Health Policy Institute.

The researchers said there is too little information yet to know whether the pilot saves any money for taxpayers or improves care to patients — two of its stated goals. But the report cited complaints from doctors in Duval and Broward counties about paperwork hassles and helping patients get permission to see specialists.

Patients have registered confusion in how the program works, the researchers said, adding that the project “appears to be moving in the wrong direction.” (See Florida Health News’ coverage of the Georgetown report.)

When he read the legislative budget request, Greg Mellowe of the consumer group Florida CHAIN quickly put out an e-mail alert on it Friday evening, and buzz built over the weekend. In the Florida Health News article on it Monday, Mellowe said AHCA was “in denial about the problems dogging the Reform Pilot.”

However, Senra said, essentially, that all the hand-wringing by advocates jumped the gun on what was essentially a pro forma exercise required under legislative rules. AHCA submitted something similar last year, he said.

Mellow remained unconvinced on Tuesday, saying the document includes almost 20 pages of detailed plans for the expansion. It “does not present expansion of the Pilot as an option; it presents a very specific action plan for accomplishing it,” he wrote. CHAIN has been consistently opposed to the Reform pilot since it was first suggested by former Gov. Jeb Bush.