Florida might try to be first state to withdraw from Medicaid
Proposal would replace pilot program or state would go alone.
Posted: February 16, 2011 - 12:00am
Brandon Larrabee
TALLAHASSEE - The lead author of a proposal to overhaul the state Medicaid program said Tuesday that if the federal government rejects the plan, Florida might become the first state to withdraw from the program and instead craft its own, pared-down alternative.
The statement by Sen. Joe Negron, R-Stuart, underscored how serious members of the Senate say they are about reining in costs of the program, which provides health-care for low-income patients. Medicaid is expected to cost the state more than $22 billion in the coming fiscal year, which begins July 1.
While Negron shied away from the phrase "opt out," he was apparently referring to a provision of the federal law that allows states to leave the program altogether.
"If the federal government elects not to allow us to manage the program the way we believe is in Florida's best interests, then we'll operate our Medicaid program with our resources," Negron said.
If the state were to leave the Medicaid program, it would lose all federal funding, which covers more than half of the current system's bills. Negron said the state would use its own portion of projected Medicaid spending to provide what benefits it could, giving priority to "those on Medicaid that we believe are the most vulnerable and need the most assistance from us."
Negron stressed that he believes it was unlikely that the federal government would reject a waiver to institute the new plan. But he said the bill set to be rolled out Thursday would contain provisions that would limit the program to the what the state could fund if the federal government said no.
"We can't allow the federal government to commandeer our budget," he said.
But it's not clear that the state would actually be willing to leave the program, said Karen Woodall, interim executive director of the Florida Center for Fiscal and Economic Policy, a think tank in Tallahassee that focuses on issues for low- and middle-income families. Woodall said that move would cause an uproar among medical-care providers that count on Medicaid dollars to help fund their operations.
"We're not going to make that up somewhere else," she said. "That would be a very ridiculous thing to do."
Assuming the federal government did agree, the Medicaid overhaul Negron pitched Tuesday would replace the reform pilot program in place in Baker, Clay, Duval, Nassau and Broward counties while trimming managed-care profits, boosting payments to doctors and squeezing savings out of the program.
The plan would trade out the managed-care pilot in those counties for a statewide system and make several changes to the five-county program, including:
- Increasing the amount of funding that managed-care organizations have to devote to patient care from 85 percent in the current reform counties to 90 percent statewide.
- Almost doubling the payments to primary-care doctors under the program, paying 100 percent of Medicare reimbursement rates to doctors, up from slightly more than 50 percent today.
- Requiring the plans to guarantee the state that they will save money over the current system.
The new Senate plan would also allow patients to get a voucher to buy private insurance if they chose to do so and provide new protections from medical-malpractice lawsuits for doctors who treat Medicaid patients.
Assuming the federal government agrees, Negron said the state would save about $1 billion in the first year and $4.3 billion over the first three years of the plan.
Even before Negron's presentation, Medicaid reform was expected to be one of the marquee issues of the legislative session. The program is consuming an ever-greater share of the state's revenue as health-care costs continue to skyrocket and lawmakers reduce funding in other areas.
"Medicaid has literally hijacked our budget," said Senate President Mike Haridopolos, R-Merritt Island, who vowed that a bill would get done this year after House and Senate negotiations broke down last year.
Woodall said she agreed with the ideas of boosting state payments to doctors in principle but said it depended on how the move was achieved.
"If they're going to raise all physicians to 100 percent of Medicare," she said, "they're not going to be able to have savings unless they're whacking the heck out of benefits."
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