SOUTH FLORIDA SUN-SENTINEL OP-ED ONLINE

by Elaine Schwartz

The Medicaid Reform Pilot in Broward and Duval Counties, has been called "A Flawed Experiment" since its passage in 2005 and implementation in 2006. The state implementing agency--AHCA--has announced that it will not be expanded statewide for the moment. One can only hope that the moment lasts a lifetime. But hopes will be dashed if leadership of the Florida House of Representatives has its wish.

This pilot program is an attempt to place the $16 Billion Medicaid Budget in the hands of HMO's for capitated managed care. It is a complex plan that has the underlying purpose of paying administrative fees to contain costs. Seniors were carved out during original negotiations, but last year a program called "Senior Care" was enacted as a pilot in Miami-Dade, Monroe, Orange, Osceola, Seminole and Brevard to put all seniors on Medicaid into HMO"s.

But studies evaluating the results show the program to cause more harm than good. The statute called for an evaluation by the Inspector General of AHCA, which showed scathing deficiencies.* In addition, the Jessie Bell DuPont Fund in Duval County commissioned a private evaluation by the Georgetown University's Health Policy Institute which, in four briefing papers, clearly shows that this program will need too much money to be thrown at it for a fix. **

Unfortunately, despite the Agency for Health Care Administration's lack of enthusiasm for the pilot, there is still a push among leadership in the House of Representatives and former Governor Bush to further expand the failed pilot program. It seems the word "Reform" holds such appeal for those in power that they've overlooked the fact that the program does not work for patients or providers.

And it gets worse. It is not even clear whether the state of Florida is saving or losing money in the wake of "Reform." AHCA clearly stated that accurate cost data is not available to determine net loss or gain. How, one wonders, could such a thing come about? The answer is simple--ugly--but simple. The hastily conceived plan was rushed into implementation. Example: Fifteen health plans were approved within the first two months when it otherwise would take up to two years to approve a workable plan. Additionally, no mechanism existed to adequately monitor progress or lack thereof in HMO's. Many patients suddenly found themselves in new plans that didn't fit their needs.

The failed pilot hurts those with the greatest needs. Fiscally challenged, ailing, mentally ill, handicapped, often homeless, hearing impaired, and blind persons do not need "Reform." They need Relief. In the meantime, what happens when they don't get the medication and care they need? They complain. The pilot does not have a mechanism in place to receive, monitor, or address complaints adequately.

And it's bad for Florida business! Local providers are being squeezed by non-payment of their claims even though they provide services. With Florida's sluggish economy, we can't afford to see them fail for lack of payment. The specter of nationwide firms filling the ensuing provider vacuum looms ominously large. More dollars siphoned from Florida's dwindling resources cannot be tolerated.

So who do they complain to? ME. Fortunately, when they talk to me, they are not talking to deaf ears. I organized a Workshop in December that "shown the light" on the Inspector General's Report, fearful that it would simply be put into a file cabinet with no publicity.*** Two days later, AHCA announced its intention of "no further expansion" currently. We don't need alternative plans that will place scarce Medicaid funds in the hands of private HMO's, no matter what the plan is called. There should be no expansion in such a densely populated county like Miami-Dade. There should be no expansion to seniors, as Senior Care proposes. There should be no expansion for limited medical problems as in "only the mentally ill" as presently proposed.

There should be expansion of good plans, like the current MediPass. Although MediPass may cost more now, it will be cheaper in the long run by keeping sick folks out of the emergency rooms and utilizing improved medications. Although the push for continuation and expansion will morph and change as the legislative session unfolds, please alert your State Representatives and Senators of the dangers of this program and the need to halt it.

We must end it now.

Elaine J. Schwartz is a Democrat who represents the 99th district of the Florida House of Representatives.