Fla. project in flux ...
Privatization pilot may be grounded, take off again
Florida’s grand experiment with privatizing Medicaid managed care might be about to end amid consumer complaints. Or, it might continue for three more years. The CMS has notified the Florida Agency for Health Care Administration that it will not grant a fast-track approval to renew the 4-yearold program, under which private HMOs receive capitated payments to care for about 300,000 enrollees in five Florida counties.
The five-year program operates under a CMS special waiver that is scheduled to expire next June, and Gov. Charlie Crist in April directed state officials to request a three-year extension. That was despite the fact that the CMS notified state officials in March that it would not use an expedited approval process because it needed time to consider “issues that have been raised in reviews and evaluations of the demonstration.”
On Aug. 17, Victoria Wachino, the director of family and children’s health programs for the CMS, wrote to the outgoing Florida AHCA secretary, Thomas Arnold, saying that the federal government was not changing its position and would continue to do a thorough review of federal officials’ “concerns” about the program.
The review will allow the CMS to modify the terms and conditions of the program before approving it, the letter said.
Laura Goodhue, executive director of the patient advocacy group Florida Community Health Action Information Network, said users of the system complain that the private Medicaid HMO plans create barriers to receiving care as a way to keep company profits as high as possible. “We think that there is a place for managed care in Medicaid, but it needs to be patient-focused, not industry-focused,” Goodhue said, adding that the extra $1 billion in Medicaid money the state receives into its Low Income Pool fund from the federal government would also vanish if the pilot program ends.
In a 240-page report to the CMS this month, the AHCA said the agency receives relatively few complaints, logging a total of 267 complaints from a pool of about 311,000 enrollees between July 2008 and June 2009.
When the pilot program was approved, program officials said they planned to expand it statewide, but lawmakers in the most recent legislative session refused to approve such an expansion after several studies of the demonstration came back with mixed reviews of the program.
Users say the private HMO plans create barriers to care, an advocacy group says.