Florida Governor’s Plan to for Mandatory Medicaid Managed Care Raises Concern

A proposal by Florida Gov. Jeb Bush (R) to shift more Medicaid beneficiaries into HMOs has provoked concern among pediatricians who believe the move will reduce the quality of care for children, the Tallahassee Democrat reports. Under Florida's current system, Medicaid managed care beneficiaries either can choose an HMO or Medipass, a "primary care case management program." Under Bush's proposal, which would affect about 370,000 Floridians, all Medicaid beneficiaries -- except for those with "special needs," such as the mentally ill -- in counties with at least two Medicaid HMOs would have to enroll in one of them. According to state Medicaid director Bob Sharpe, the move would save the state $67 million because Florida reimburses doctors participating in Medipass at 100% of the cost of care, compared to 92% for Medicaid HMOs. Although Sharpe said the proposal was intended "primarily" to reduce the state's $600 million Medicaid budget shortfall, he added that it also would "allow the state to make Medicaid patients' care more specialized by moving chronically ill patients into Medipass and acute care patients into Medicaid HMOs."

Pediatric Concerns
Some of the state's pediatricians believe the governor's plan will make it more difficult for children under Medicaid to obtain a doctor. For instance, one of Leon County's two Medicaid HMOs currently has no pediatricians in its provider network, but though it plans to add one. Louis Petery, a Tallahassee pediatric cardiologist, said, "A lot of patients will lose access to a medical home and continuity of care. The governor's proposal risks pushing people into episodic emergency room care, which is much more expensive and much worse for patients." In addition, the Tallahassee Pediatric Foundation, a case management agency, has said the governor's proposal could "mean the end of the foundation" because all its member physicians participate in Medipass, and 60% of the program's funding comes from Medicaid. The foundation acts as a "gatekeeper," ensuring patients receive care even if they temporarily lose Medicaid benefits, Carol McCormick, the foundation's nursing director, said. She added, "Our experience has been that children don't get the same levels of care and local case management with Medicaid HMOs as they do through Medipass. HMOs don't know these kids, they don't have any relationship with them, yet they're responsible for their care." The Senate Appropriations subcommittee on health and human services is expected to debate the proposal, which is contained in Bush's proposed budget, this week (Sams, Tallahassee Democrat, 3/12).