by Jim Saunders
Health News Florida
A House committee will move a step closer to revamping Florida’s Medicaid system today when it approves a bill to gradually shift almost all beneficiaries into managed-care plans.
In the coming weeks, the full House is almost certain to follow suit.
That is only part of the equation for overhauling the $20 billion health care system, with House and Senate leaders needing to reach agreement this spring on a final Medicaid plan and, ultimately, needing to seek federal approval.
So far, the House and Senate have proposed Medicaid-reform bills that include substantial differences.
Among other things, they disagree about how to break the state into managed-care regions and how to hold HMOs and other types of plans accountable for serving beneficiaries.
Senate Health and Human Services Appropriations Chairman Joe Negron (R-Stuart) said Wednesday that House and Senate officials have been holding informal discussions about bridging their differences.
Republican leaders agree they need to change the Medicaid system to limit its steadily increasing costs.
“There are differences, but I think the overall goal is the same –- to bring budget predictability to Medicaid,’’ said Negron, the chief architect of a Senate proposal released last month but yet to face a committee vote.
Here are some of the key questions that the House and Senate will have to answer:
Who should be included in managed care?
Both the House and Senate would enroll the vast bulk of Medicaid beneficiaries, such as children, women and seniors who need long-term care.
The chambers disagree about whether thousands of people with developmental disabilities, such as autism and mental retardation, should be required to enroll in managed care. The House wants to include that group, while the Senate would not.
How should the state be carved up for a managed-care system?
Under the House and Senate proposals, managed-care companies would compete for Medicaid contracts in different regions of the state.
The House wants to carve the state into seven regions, while the Senate favors 19 smaller regions.
The answer to this question is important, at least in part because regions have to include enough Medicaid beneficiaries to make them financially viable for managed-care plans.
How would managed care be phased in?
The Senate wants to move much faster than the House, proposing that the statewide managed-care system would be in place for most beneficiaries by Dec. 31, 2012. For long-term care, the deadline would be March 31, 2013.
The House, meanwhile, would start with long-term care being fully implemented by Oct. 1, 2013. For the broader Medicaid population, the target date would be Oct. 1, 2014. For people with developmental disabilities, it would be Oct. 1, 2016.
How would managed-care plans be held accountable?
The House and Senate both would require managed-care plans to sign five-year contracts but would take different approaches to ensuring that the system provides quality care.
One of the issues, for example, centers on making sure HMOs and other plans spend enough money on patient care.
The Senate would require plans to spend 90 percent of the money they receive on care –- a concept known in the insurance industry as a “medical loss ratio.’’ The House, meanwhile, would use a profit-sharing formula that would require plans to send money to the state if they make more than 5 percent in profits.
Health News Florida is a partner of the News Service of Florida