December 11, 2013
By Aaron Deslatte,
TALLAHASSEE — A new Georgetown University report is questioning whether Florida’s handover of millions of Medicaid patients to managed-care companies will be able to achieve the twin goals of cutting costs and improving health.
In short, the first steps of the changeover had some “glitches” and left some patients in MetroOrlando confused and concerned about whether profit-seeking HMOs would have their interests at heart, the report’s author said Wednesday.
The state Agency for Health Care Administration was “confronting a new business model. … So it was difficult sometimes for them to reassure their clients that nothing would change in the future,” said Laura Summer, the report author with Georgetown’s Health Policy Institute.
Florida policymakers have been working since then-Gov. Jeb Bush pushed the effort in 2005 to create a statewide, managed-care version of its Medicaid health-care program, which has 3.5 million people enrolled and will cost $22.9 billion this year.
In 2011, the Legislature passed a bill to start phasing in the statewide privatization, first for long-term care services for seniors and the disabled and then for all populations.
The federal government approved both steps earlier this year, and enrollment in the long-term managed care program started in Orange, Seminole, Osceola and Brevard counties last August. There were just over 9,000 people eligible for the program in those counties this fall. The shift kicked off in Broward County in November, and is starting in Miami-Dade this month.
Medicaid patients in the long-term care program are typically the most costly, and require help daily help with bathing, dressing, eating, or medication management at nursing homes, assisted-living centers or in their homes.
The Georgetown study was conducted in concert with several advocacy groups including the Florida AARP and the Winter Park Health Foundation, and involved conducting interviews with Medicaid enrollees handed over to managed-care companies.
The feedback was mixed, and the report raises a series of questions surrounding whether private HMOs will behave more opportunistically than public health-care officials.
Although the shift was phased in, more “lead time was needed to get contracts and provider networks in place, train staff and resolve billing and payment questions,” the report said.
More than one-third of enrollees didn’t select a provider, “suggesting that more expansive information and counseling efforts are needed.”
Part of the rationale for reforming long-term care was to keep more seniors in their homes through community-based nursing and health-care providers. But the report noted that the waiting list for community based care had grown from 34,600 in 2012 to 40,490 this fall, while the waiver approved by the federal government set an enrollment cap of 36,795 slots for community-based care.
“Thus, unless the waiver is amended to increase the numbers served in the community, long waiting lists will persist,” the report noted.
Summer said the findings suggested the state needed to do a better job explaining the changes to patients, and that questions remained over how the program will look after its first year and whether current health-care providers would keep their contracts.
The shift of other Medicaid patients to managed-care companies is slated to start in May 2014
