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THE PROGRAM
Medicaid is the state-federal program that provides health benefits to lower-income children, pregnant women, parents, people with disabilities, seniors and others.
THE PROBLEM
“I’m absolutely convinced this will prove to be cost-effective.”
 — Tom Arnold, deputy secretary for Medicaid
at the Florida Agency for Health Care Administration
[Photo: Ray Stanyard] |
Medicaid spending in Florida is spiraling out of control: In 2005-06, Medicaid costs were 22.5% of the state’s budget. The Florida Agency for Health Care Administration (AHCA) projects that if left unchecked, Medicaid will consume 59% of state spending in 2015. The current program has other problems, particularly in providing access to specialists. “We all agree that Medicaid does need to be reformed,” says Andrew Leone, policy and communications director of Florida CHAIN, a statewide consumer healthcare advocacy organization.
THE EXPERIMENT
Over the past year, children, parents and disabled people on Medicaid in Broward and Duval counties have been required to obtain their healthcare through health maintenance organizations (HMOs) or provider service networks (PSNs) instead of the state’s traditional MediPass fee-for-service system.
Broward County residents participating in Medicaid reform choose among 10 HMOs and five PSNs, including a specialty plan to serve children with chronic conditions. In Duval, four HMOs and three PSNs are participating. In Baker, Clay and Nassau counties, there is one HMO and one PSN.
“Not knowing which plans cover which drugs is a major problem.”
 — Andrew Leone,
policy and communications
director of Florida CHAIN, a consumer advocacy group
[Photo: Eileen Escarda] |
Participants choose their plan based on their specific needs and the participating physicians. The plans include all benefits mandated by the federal government but vary in terms of optional benefits like prescriptions and outpatient services such as physical therapy.
Participation in the pilot isn’t mandatory for individuals with developmental disabilities, pregnant women and seniors who are eligible for both Medicare and Medicaid, nor for Medicaid beneficiaries in nursing homes and hospices.
In the counties using the pilot program, “I think that the implementation has gone pretty smoothly,” says Sen. Nan Rich, a Sunrise Democrat who co-sponsored the original legislation and is vice chairman of the Senate
Health and Human Services Appropriations Committee. Tom Arnold, deputy secretary for Medicaid at the Florida Agency for Health Care Administration, agrees.
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