TALLAHASSEE, FL—Florida Gov. Rick Scott’s controversial plan to privatize Florida’s Medicaid and CHIP programs covering 2.9 million people continued to move through the Florida legislature last month, though a May 6 end to the current session will leave the House and Senate a short window to reconcile the two versions of the bill.
The Senate version, which emerged from the Budget Committee in mid-April and was set for a vote of the full Senate after press time, included a provision for a hard cap on Medicaid spending in each yearly budget. It would also require Florida to be granted a Medicaid waiver and lacking such waiver provides for steps the states can take to leave the federal Medicaid program altogether.
The Senate bill has been shepherded through committee by Republican Sen. Joe Negron, who has made the Medicaid spending cap a priority. “We as a legislature will decide, ‘This is how much we're going to spend on Medicaid,’” Negron told reporters before the Senate Budget Committee passed the bill and sent it for a full vote in the Senate.
At the heart of the both the Senate and House versions of Medicaid overhaul is a shift of Medicaid recipients to managed care programs. Florida currently has a waiver from the Centers for Medicare and Medicaid Services for a five-county managed care pilot proponents say has proven viable as a cost saving measure. The pilot’s waiver expires June 30 and expansion of the program would require extending that waiver.
In January Gov. Scott sent a letter to HHS Secretary Kathleen Sebelius requesting an expedited decision on an extension of the existing waiver.
“A substantial review including multiple evaluations of the waiver have been conducted and indicated the state has implemented all components of the waiver and has met or exceeded requirements and, in addition, has resulted in improved outcomes and increased satisfaction among participants,” Scott wrote in the letter. “CMS approval of the waiver will provide the state with the ability to maintain the program and budget certainty regarding the availability of Low Income Pool.”
The letter also cautioned HHS that any waiver granted but with changes proposed by CMS would not be received well, noting that any changes should not represent “micromanagement” and should provide value in administering the program. “As such, CMS should not unilaterally require changes to the program without agreement from the state.”
But critics aren’t convinced the five-county pilot has proven that a statewide managed care program for Medicaid would be effective and worry that services would be curtailed.
“I have a major problem with the premise of doing a massive expansion to a managed care experiment that we don’t know if it works,” said Democratic Senate Minority Leader Nan Rich, who also opposes the bill’s proposal on a hard spending cap for Medicaid.
Florida Community Health Action Information Network (CHAIN), an advocacy group for Medicaid patients and providers, noted “this risky proposal would put the interests of for-profit companies before those of Florida health consumers and taxpayers. It builds on a failed Medicaid Reform program that has a long list of problems that haven't been fixed including a lack of transparency and oversight. These bills do not offer consumer protections or proven methods of saving Florida money.”
Further opposition comes from the Florida Center for Fiscal and Economic Policy. In a report examining the Senate bill’s Medicaid proposal, the center applied a spending cap model similar to the one proposed if the cap had been implemented in 2008-2009 and run through the current year.
“By 2010-11, the capped budget of $16.38 billion would have fallen a massive $3.81 billion below the actual amount appropriated,” the reports said. “Consequently, what would remain of Medicaid under a cap would no longer be recognizable as Medicaid in very short order.”
If the Senate bill passes, it is unlikely it would emerge as law intact due to significant differences in the House version, which doesn’t include a hard spending cap for Medicaid. The House version also does not include a provision for walking away from federal Medicaid matching funds if the state doesn’t receive a waiver for its Medicaid overhaul, a move that would cost the state $12 billion of its $21 billion Medicaid budget.
House and Senate negotiations are ongoing and it is unclear whether the two chambers can deliver a reconciliation bill before the May 6 end of the legislative session.