Medicaid Reform: A Failed Experiment Florida CHAIN November 12, 2008
WHAT is Medicaid Reform? Florida CHAIN “ Medicaid would work much more efficiently and effectively if it looked more like private insurance.” INPUTS: Competition + Transparency + Data-Driven Decisions + Meaningful, Informed Choice OUTCOMES: More Options + Improved Health + Cost Savings
Reality of Problems
Limited access to providers
Shortage of participating specialists
More frequent denials of services
Longer delays in approval of services
No information on Preferred Drug Lists
No information on right to disenroll
WHERE Is Medicaid Reform? Florida CHAIN
Don’t we already have Medicaid HMOs all over Florida?
Key difference in Medicaid Reform Counties is that HMOs can:
“ determine the duration and scope of services and benefits”
How are Seniors affected by Medicaid Reform
Approximately 197,000 Medicaid beneficiaries enrolled in Reform in the pilot counties now
Approx. 2,700 are dual-eligible for Medicare and Medicaid
Suppose to be voluntary enrollees- process confusing
Approx. 2,000 Seniors in Broward enrolled in Medicaid Reform
Senior Care Pilot legislation
Medicaid Reform just for Seniors
Senior Care Pilot Program was to be implemented in Central Florida December 2008
Delayed indefinitely. Need legislation not to proceed.
Would have been voluntary
Doesn’t mean it’s off the table- mandatory participation would mean more HMOs would participate
Evaluations – Past and Future
Office of Inspector General
University of Florida
Health Advocates (Florida CHAIN, Florida Legal Services, etc.)
Reasons not to Expand Medicaid Reform
Many consumers are suffering under Reform.
Consumers are experiencing tremendous challenges due to denials of service, providers dropping out, preauthorization requirements, unavailability of prescription drug formularies, and bureaucratic confusion.
The growth in Medicaid spending has not been out of control since before Reform began.
The most recent forecast made by State economists is that total Medicaid spending will be $38 billion lower than had been projected back in 2005.
Reform is not saving the State money.
At last review, Medicaid spending per person was only about 2% less in Reform than in the rest of Medicaid. This is certainly a worse deal for taxpayers because Reform allows plans to provide a lower level of service. In fact AHCA submitted a $6.7 million budget to expand Reform outside the pilot counties.
More Reasons not to expand Medicaid Reform
HMO’s are threatening to pull out of the Medicaid Reform pilot.
Medicaid Reform promised to increase competition among plans so that consumers could have more and better choices available to them. However, in October, three HMOs pulled out of the Pilot.
Medicaid Reform does not ensure accountability nor measure if people are getting healthier.
Reform was to “focus on transparency and public reporting of outcomes”, and we have yet to see the first plan-by-plan reporting of quality, access or anything else.
Medicaid Reform provides very little “consumer empowerment” and “informed choice”.
Consumers have had as many as 17 different plans to choose from, each with a different group of providers, amounts and levels of service, drug lists, copayments, and additional services. Because of this confusion, studies have shown that plan selection is usually based on which one’s current primary care provider is enrolled.
Medicaid Reform outside of the pilot counties? Florida CHAIN MEDIPASS MEDICAID MANAGED CA RE Erosion of Medipass = Expansion of Medicaid Managed Care