Fla. project in flux ...

Pri­va­ti­za­tion pi­lot may be grounded, take off again

Modern Healthcare - - The Week In Healthcare - Joe Carl­son

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.

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