The Plot Thickens on Florida Medicaid Reform

July 20, 2011
|In Medicaid
|By GHG Advisors

Government health programs geeks like me are closely watching developments in Florida as Governor Rick Scott attempts a drastic overhaul of his state’s Medicaid program. The state intends to seek a broad waiver of Medicaid requirements from CMS on August 1 to force almost all beneficiaries in the state into health plans, including the Aged, Blind and Disabled.

The “ABDs” are considered by industry watchers to be the “Final Frontier” for health plans in the program, with most of the TANF population (moms & kids) already enrolled in HMOs. These are, of course, the most vulnerable patients in the health system, so how initiatives like Florida’s go is a harbinger of what’s to come in other states as more are forced to confront harsh budget realities.

As Florida’s submission to CMS nears, advocacy groups are sounding the alarm.  Florida’s record on management of ABDs under the state’s Section 1115 and 1915(c) waivers hasn’t gone well and there is reason for concern about a rush into health plans for these beneficiaries.

But we’ve seen time and again how these vulnerable populations can be well-served by health plans when they are aggressively regulated and monitored by Federal and state officials: Minnesota’s Senior Health Options (MSHO) or Medicare Part D for dual eligibles, to name a few.

The problem is Gov. Scott, the former CEO of HCA during its massive Medicare fraud case, is not a fan of government regulation or monitoring. If CMS makes too many demands, the Governor has threatened to eliminate Medicaid in his state altogether — turning his back on over $14 Billion in annual Federal matching funds. You can imagine the politics around this filing. If he wins this game of chicken you can expect other states in similarly dire financial straits like Texas to follow suit.

CMS’s handling of Florida’s application this fall should be a clear indication of how much maneuvering room the Obama Administration will give to fiscally-challenged states — and that’s a long list. Stay tuned.