Negron: Medicaid rewrite “bold” not “sniveling”by John Kennedy | March 30th, 2011
A Medicaid rewrite that would steer 2.9 million low-income sick and elderly Floridians into managed care programs across 19 still-to-be-established regions cleared its first hurdle Wednesday in the state Senate.
The Health Regulation Committee approved the measure 11-0, despite concerns from some lawmakers that the legislation threatens many low-budget, community care providers who currently serve thousands of elderly Floridians in their homes.
Critics said they fear these providers could be hard-pressed to win contracts and play a role in a new system dominated by large HMOs and hospital-driven Provider Service Networks (PSNs).
But Senate sponsor Joe Negron, R-Stuart, said that competition was key to assuring that Medicaid patients received better and more efficient care.
Negron said lawmakers are looking to cut $1 billion from Medicaid’s current $22 billion budget, which now represents almost one-third of the state’s recession-wracked state spending plan.
“I want this bill to be bold and transformative, rather than just sniveling around the edges,” Negron said.
But Sen. Mike Fasano, R-New Port Richey, proposed a series of amendments to the Medicaid proposal (CS/SB 1972) aimed at giving preference to community organizations. Negron pushed back, saying such guarantees would undermine the “entrepreneurial” goals of the new system.
“We’re not carving anything out,” Fasano insisted. “We’re just leveling the playing field so (community groups) can try to compete, too.”
The Senate is expected to hold at least another public hearing on the bill before it heads for a full chamber vote. The House is moving more swiftly with a competing version of Medicaid overhaul, setting Thursday for a final vote. The two sides are expected to soon begin negotiations on a consensus plan, with a May 6 end-of-session deadline looming.
A range of differences separate the proposals. But the Republican-ruled House and Senate agree on the managed care approach.
The underlying premise of the Medicaid revamp is to improve health care services by giving managed care plans authority to design programs that meet the specific needs of patients, improve preventative health, and promote cost-saving competition between the plans.
Instead of sick or injured patients showing up in doctor’s offices or emergency rooms seeking treatment – with bills paid directly by Medicaid – HMOs now would guide patients into health plans and manage the dollars.
Within these plans, patients could choose among a network of doctors, while getting prescriptions from formulary lists approved by the managed care plan.
The Medicaid overhaul — like the House counterpart — includes provisions aimed at reducing the legal liability of health-care workers and organizations that treat Medicaid patients.
Among the most controversial measures, the Senate would cap financial awards involving agencies providing foster care services at between $200,000 and $1 million, and limiting economic damages at $2 million. The limit has drawn criticism in the wake of the death of 10-year-old Nubia Barahona and near death of her twin brother, Victor, allegedly at the hands of foster parents who drew shoddy oversight from a Miami-Dade children’s agency.
Similar legislation is advancing in the House and Senate, supported by agencies which say rising insurance costs are threatening their ability to continue operating.
“There’s a delicate balance between the rights of individuals to seek redress for their injuries, while at the same time making sure that there are insurance policies for them to make claims against,” Negron said.