House bill would turn Medicaid into managed care

Two bills approved Monday by the House Policy Council on Strategic and Economic Planning could privatize Medicaid in every Florida county, saving Florida billions of dollars.

HB 7223, co-written by Rep. Denise Grimsley, R-Lake Placid, would change from a fee-for-care system, in which more than 2.7 million patients are treated by a caregiver who bills the state.

Moreover, Florida's Medicaid could enroll more than a million new participants under the new federal health care bill. The new PSN will use a combination of federal and state taxpayer funds to provide free health care for the eligible population.

Under the proposed system, doctors, hospitals, nursing homes and pharmacies would be allowed to participate or start their own Provider Service Networks, modeled after the HMOs and PPOs with which most workers are familiar.

"Plans must be selected by the Agency for Health Care administration based on quality and, if selected, must serve the entire region," Grimsley said.

Under the five-year plan of HB 7223, which went to the House floor on Thursday, Florida would be divided into six regions. Each region would have from three to 10 managed health plans for all covered services.

PSNs, Grimsley said, "will deliver budget predictability and coordinated care for the recipient."

"As Florida experiences the most challenging economic times in memory, it is even more apparent that the current Medicaid system is unsustainable," Grimsley told the Gainesville Sun.

The Senate has approved a different bill, on a smaller scale, which would add 19 more counties to the five involved in a test of the program.

"Reform has increased competition among health plans, reduced co-pays and expanded and diversified patient benefits," Michael Bond, a James Madison Institute senior fellow in Tallahassee, told the Fort Myers News-Press.

A study of the reform pilot program by the University of Florida showed a reduction in the per member per month Medicaid costs by as much as $95 for those enrolled in a Provider Service Network and $26 per member per month reduction overall, the News-Press reported.

However, the HMO-PPO models face opposition from the Florida Hospital Association and the Florida Medical Association.

"It's not a realistic option," Jeff Scott, FMA general counsel, told the News-Press. "They know it won't work on a statewide basis. This would just hammer physicians into involuntary servitude."

"As a nurse," said Grimsley, an RN at Florida Hospital Heartland, "I see myself first as a patient advocate, but as a legislator, I also have a fiduciary responsibility to the taxpayers.This plan, I believe, demonstrates a fully integrated managed care model that will achieve both goals."