Miami Herald - June 30, 2006
John Dorschner, jdorschner@MiamiHerald.com

Starting Saturday, Gov. Jeb Bush's project to privatize Medicaid will begin in Broward and Duval counties.

The ambitious pilot aims to give the poor and disabled who use Medicaid a broad range of choices -- at least some of which offer more benefits than they're now receiving -- while curtailing increases in government spending, which has soared from $7 billion to $16.7 million during Bush's seven years as governor.

"I'm committed to making Medicaid reform work," said Alan Levine, a former Bush assistant who as secretary of the Agency for Healthcare Administration crafted the reform package and will see its effects firsthand now that he's been picked to be chief executive of the North Broward Hospital District.

"In some ways it sounds too good to be true," said Anne Swerlick of Florida Legal Services, an advocate of the poor. "There's a whole vast array of problems that may arise."

The change is complicated by a new federal requirement that, starting Saturday, says Medicaid recipients who are citizens will have to prove their citizenship in order to receive benefits. Some, but not many, noncitizens qualify for Medicaid, and their coverage will not be affected.

Advocates for the poor throughout the nation have complained the citizenship requirement will put an unnecessary burden on recipients and delay their coverage. A lawsuit was filed earlier this week in Washington attempting to delay the requirement.

Florida officials say no present Medicaid recipients will immediately be denied coverage, but they will need to prove citizenship at their annual reenrollment.

New applicants will have to offer proof before being admitted to the federal-state program.

"It's going to discourage people from going into the program," Swerlick said. "Some of the people with cognitive impairments and others are going to have trouble getting the paperwork together. How easy is it for you to find your birth certificate? There are a lot of concerns."

Meanwhile, Levine was upbeat about the 11 private plans that have been approved to operate in Broward. He said many of them are offering benefits -- such as dental care for adults -- that traditional Medicaid has not provided in the past.

"We think there will be an expansion of Medicaid services," he said, as the health plans compete to provide the best offerings. "The plans that do a good job will succeed, and the plans that don't do a good job won't."

Humana, Vista Health Plan of South Florida, United Healthcare, Total Health Choice and Amerigroup are among those offering plans. Blue Cross Blue Shield of Florida, though its home base is in Jacksonville, one of the two pilot sites, has decided not to participate.

About 170,000 Medicaid recipients live in Broward, said Joe Rogers of the North Broward Hospital District.

Of these, about 120,000 will be required to move into the pilot project by picking a health maintenance organization or a provider service network, such as the South Florida Community Network, which is made up of the clinics, hospitals and staff of the North and South Broward hospital districts and Jackson Memorial Hospital in Miami.

The pilot is targeting low-income, single-parent families, families with a disabled or unemployed parent, children with chronic conditions and HIV/AIDS patients. These groups tend to have the most expensive Medicaid patients.

The state plans to contain spending by capitating the health plans -- which means setting limits on how much they can spend per patient. The concept is that the private plans will do a smarter job of managing care than the government has done.

Critics are concerned that recipients may have problems picking the best of the 11 offered plans.

"Look at the Medicare Part D debacle," said Swerlick, "with all the confusion about choosing drug plans. It gets so confusing that we know [Medicaid recipients] are going to have trouble."

Levine said the state understands this challenge and has trained "choice counselors" to help recipients through the process. Fifty counselors will be in a call center to answer recipients' questions. Sick and disabled persons who are homebound will be visited by a counselor.

"They're banking on the choice counselors to make this program a success," Rogers said.

Because of the complex choices, the program is being phased in slowly. Starting Saturday, Medicaid recipients will start getting information about their choices, and by Sept. 1, the first group of 20,000 to 30,000 will need to be enrolled in plans. After that, about 25,000 each month will be required to sign up until all have chosen a plan.

Ideally, the health plans will offer patients better coordination of treatment, said Rogers of the North Broward Hospital District, with more of an emphasis on preventive care and fewer trips to the emergency room for expensive, chronically ill patients.

"This is a five-year experiment," Swerlick said. "There is no protection against agencies starting off with more generous benefit packages. . . . It doesn't preclude them with ratcheting down the package each year."

And in fact, to keep costs under control with a rising population, they might have to do that, she said.

"This is the starting point," said Levine, the architect of the reform. "We're committed to learning and adjusting as we go."

060630
MH060615

Always watch for outdated information. This article first appeared in 2006. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2006. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .