MIAMI — In a sweeping overhaul of its $21 billion Medicaid program, the Florida Legislature approved a bill Friday to shift nearly three million Medicaid recipients into managed-care programs in the hope of saving money and improving services.
“Medicaid has grown faster than any other part of our budget,” said State Senator Joe Negron, Republican of Stuart, who took the lead on the bill. “It is crowding out funding for education, economic development and other parts of the budget that are equally important.”
If signed into law as expected, the bill will make Florida, with one of the largest number of Medicaid patients and a high rate of uninsured, one of the biggest states to jump almost entirely from a traditional Medicaid payment system into managed care. The wholesale shift would begin in July 2012.
The bill, a compromise between the House and the Senate versions, would allow the state to decide how much to spend on Medicaid each year, share in the profits of managed-care companies if they exceed 5 percent and penalize networks that reneged on contracts. To help ensure better care for patients, the bill would also require plans to include specialists and provide higher reimbursement rates to doctors.
Patients would be charged $10 monthly premiums and $100 if they showed up at the emergency room with a non-emergency.
The state and managed-care companies would control which services to provide to Medicaid patients. In so doing, the legislation would do away with the existing fee-for-service system, in which the state pays providers for each service, a practice that has led to widespread fraud and inconsistent care. Reimbursement rates have dropped so low that many doctors choose not to treat Medicaid patients.
The Legislature’s bill seeks to remedy those issues with the requirement that plans include specialists and the higher reimbursement rates to doctors.
Another sweetener for doctors and hospitals is a provision that limits the amount they would have to pay out in malpractice damages for pain and suffering to $300,000 for each Medicaid claimant, unless the damages award is punitive. Senator Negron said the cap was appropriate because doctors who treat Medicaid patients are basically providing a public service and should be encouraged to do so.
But Democrats said it would be unreasonable to charge poor patients fees and unjust to treat them differently in malpractice cases. “Why is it that their pain and suffering is devalued?” asked State Senator Arthenia L. Joyner, a Democrat of Tampa.
Gov. Rick Scott, a wealthy former health care executive who made revamping Medicaid a priority, supports the legislation, which is projected to save $1.1 billion in its first year.
But the proposed law cannot go into effect without the approval of the federal government, which pays more than half of Florida’s Medicaid tab. Last month, the federal government advised legislators to choose the payment system that would guarantee that a percentage of the money, in this case 90 percent, would go to patient services. Instead, the Legislature chose the other option: to share profits with managed-care companies.
But Senator Negron said he was not worried. “We have given the federal government a hundred good reasons to approve our plan,” he said. “I think they will work with us because they have the same economic pressures that we have.”
Democrats and patient advocates said that they worried profit would get in the way of care and that some people would not be able to pay premiums. They expressed alarm that the bill is based on a five-year-old pilot program in five Florida counties that had decidedly mixed results. At least seven managed-care companies pulled out of the program in Broward County, and many patients — most of whom are low-income children or pregnant women — fled to networks run by hospitals.
Managed care is not new to Florida. About 60 percent of Medicaid patients are in some form of managed care but, outside of the pilot program, they must receive a mandated minimum level of benefits.
The Medicaid overhaul also extends into long-term care. Nursing home residents would shift into managed care, but the bill provides a separate provision for them. Payments would go directly to the nursing homes, bypassing managed-care companies, so money would not be deducted for administrative fees. Savings would come by shifting more people into home- and community-based programs.
Developmentally disabled people would be exempt from the managed care system for now. And each of the 11 managed-care regions in Florida would have to include a network run by a hospital or doctors. Those networks could continue to use the traditional payment system for three more years.
Those who already have insurance and are eligible for Medicaid would receive a voucher from the state to apply to their policies.
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