Bill would limit funding for Fla’s Medicaid pilot

Mar 4, 2009

Sarasota Herald-Tribune–March 2, 2009

The Associated Press

TALLAHASSEE, Fla. – A lawmaker has filed a bill seeking to limit the state’s authority to operate a Medicaid privatization experiment even as state officials have begun to take a stand against the troubled pilot program.

The proposal seeks to revoke the Agency for Health Care Administration’s power to get money from the federal agency which helps fund the pilot program. Rep. Elaine Schwartz, D-Hollywood, said her office is flooded with residents who can’t get doctor’s appointments and medicine.

Schwartz, who filed the proposal, said she would have filed a bill to stop the pilot program altogether, but the deadline had passed.

Limiting AHCA’s funding from CMS for programs like the pilot “was the only club I had to make this statement,” she said. “This is a program that not only should not be expanded but should be stopped because innocent people who need medical care are being injured.”

“AHCA will continue to evaluate all components of the pilot and make appropriate revisions to ensure access to medical services for Medicaid beneficiaries. Of course, the Florida Legislature can take whatever action they deem appropriate,” the agency said in a statement Monday.

The bill was filed days after officials in Broward County, the largest of five participating, passed a resolution saying they want out of the troubled pilot because residents are delayed medical treatment.

When it passed in 2005, Gov. Jeb Bush touted the five-year pilot, which operates similar to an HMO, as a national model for improving care while limiting state costs. Since then, a flood of critics say the program is mired in bureaucracy, and patients complain they struggle to get treatment.

An Associated Press study found that nearly 25 percent of doctors in Broward and Duval counties have dropped out of the plan, saying the pilot limits them from treating patients as they see fit.

Under the pilot, the government pays private companies a set amount for handling a specific number of residents in the counties. The companies then decide their care, including which doctors they see and what medicines and treatments are prescribed.

Critics say the pilot allows private providers unprecedented levels of flexibility with little accountability because there is no formula ensuring the HMO spends a certain amount on health care.