Infection Control Plan

Florida's Medicaid program heading to managed care system

As Washington grapples with debt ceilings and spending, another set of fiscal negotiations quietly begins this week that will impact Floridians for years.

The Legislature voted in May to turn the state's entire Medicaid program over to private managed care. But because the federal government shoulders most of the bills, the Obama administration must give its assent.

At stake are billions of tax dollars and the health of more than 3 million poor and elderly Floridians. The debate around the issue already is dividing along philosophical and political lines.

Democratic legislators wrote a letter this month urging federal officials to veto the program.

Florida already tested managed care — in a five-county pilot project that "has been plagued with problems,'' the Democrats said.

"Now, the legislation calls for expansion of Medicaid managed care plans to all 67 counties … while giving those plans unprecedented flexibility to vary the amount, duration and scope of benefits in confusing and risky ways.''

State Sen. Joe Negron, R-Palm City, countered that managed care is a nationwide trend that can control costs and improve services.

"What Florida is asking for is well within the mainstream,'' said Negron, who spearheaded the legislation. "Hopefully, the current administration will give Florida the flexibility to manage a Medicaid program we can all be proud of.''

But if Washington throws up too many roadblocks, he said, "the federal government commandeering a state budget will be a national political issue.''

Florida's Agency for Health Care Administration is scheduled to submit details of the plan today to the federal Centers for Medicare and Medicaid Services, which will evaluate it, make tweaks and possibly demand revisions. Such negotiations can easily take six months to a year.

By the Legislature's timetable — which Washington need not heed — the state would begin negotiating contracts with managed care companies next July, with actual care starting in 2013.

The new system would divide the state into 11 regions, with as few as two managed care plans in the rural Panhandle and as many 10 in populous South Florida.

Clients would select a plan or be assigned one. Plans would collect a per-client stipend from the state and provide all care through a network of doctors, hospitals and other services.

Plans, often run by insurance companies, could make a profit if they treat clients for less cost. Not-for-profit networks of hospitals, nursing homes and other care providers could also set up their own managed companies.

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