Grimsley to lead Medicaid reform

Health and human services consume 38 percent of Florida's entire $69 billion budget.

"It just continues to grow," said Denise Grimsley. On Wednesday, House Speaker Larry Cretul decided the Lake Placid Republican should lead the reform.

"I'm really wanting Denise and her group to work that," said Cretul.

Grimsley, a University of Miami M.B.A., chairs the Health Care Appropriations Committee and is the vice chair of the Select Policy Council on Strategic & Economic Planning. She's also on the Appropriations Council on General Government & Health Care and the Health & Family Services Policy Council, as well as three more policy and budget committees.

As for exactly how Florida's free health care system ought to be reformed - well, that's what Grimsley and those committees are supposed to decide. Their recommendations will be heard by the House.

One option: the Agency for Health Care Administration says 19 of Florida's 67 counties could be added to the Medicaid pilot project. It already contains three urban and two rural counties.

The pilot project has shifted patients from the current system - where patients simply see a doctor, who bills the state for the service - to an HMO or PPO like most workers have. Health care companies like Blue Cross or United would manage the care.

"We could look at moving nursing homes into managed care," Grimsley said. "Georgia put everyone in managed care. The problem is, in rural communities, there aren't enough managed care corporations. I think in Highlands County, we only have two. Little counties like Hardee may have only one."

The News Service of Florida reported Thursday that AHCA is suggesting to lawmakers that the counties could handle a program that would shift 375,000 more Medicaid recipients into managed care networks or plans. The state could save $58.7 million to the state.

"That's not much," Grimsley said, although she's neither for nor against the idea yet. The state is looking at a $3 billion shortfall in fiscal year 2010-11.

"We could make it work, but the House is not looking at that," said Grimsley, a registered nurse who was elected in 2004.

Florida's Medicaid program is the fourth largest in the country, covering some 2.1 million people each month. There are more than 80,000 service providers.

Her committees are focusing on two issues: uniformity and fraud.

There are exceptions to the state Medicaid system for diseases, providers and areas of the state, Grimsley said.

"Each county has something a little different," said Grimsley.

Fraud is a far larger problem. "We have to cut out fraud," she said.

Last year's Office of Program Policy Analysis and Government Accountability report estimated from 5 percent to 20 percent of the $16.2 billion annual Medicaid budget - from $800 million to $3.2 billion - is consumed by fraud, waste and abuse.