Lawmakers said the program was overwhelming the state budget and needed to be privatized to rein in costs and improve patient care. Critics fear the bills build on a flawed five-county experiment where patients struggled to access specialists and doctors complained the treatments they prescribed were frequently denied.
State Sen. Joe Negron, who spearheaded the overhaul, said leaders have learned from the pilot program's shortcomings and it now includes increased oversight and more stringent penalties, including fining providers up to $500,000 if they drop out.
The measures also increase doctors' reimbursement rates and limit malpractice lawsuits for Medicaid patients in hopes of increasing doctor participation in the program.
The bills (HB 7107 and HB 7109) also require providers to generate a five percent savings the first year, which could save the state about $1 billion.
Long-term care patients will be the first to enroll in the statewide program starting in October 2013. The rest of the population will join the following year. The developmentally disabled population will not be included in the privatization program and will operate for three years under an “I Budget,” which offers patients more flexibility.
Those seniors were not included in the original part program “because everyone knew they were too frail,” said Rep. Elaine Schwartz.
“Extra vulnerable seniors who do not have the stamina to struggle with the Medicaid web of claim denials that HMOs practice should not be the first to be thrown under the bus, state-wide,” said Schwartz, a Democrat from Hollywood.
Democratic leaders in the House and Senate voiced concerns about the statewide expansion, saying there was little evidence the pilot program improved patient care or saved money after five years. Critics also worry the state is abdicating care of its most vulnerable residents to for-profit companies with little oversight of how the money is being spent.
The bills removed a requirement for plans to spend certain percentages on patient care and administrative costs. Federal health officials encouraged state lawmakers to include that provision in the bill.
Instead, the bills call for managed care plans to repay profits over five percent to the state.
The plan divides the state into 11 regions where managed care plans and hospital networks will bid on contracts to serve certain regions. Critics worry the regions are too large and that patients will have to drive long distances to see doctors. The House originally proposed eight regions.
Federal health-care officials still have to approve the plan. The Centers for Medicare and Medicaid Services (CMS) sent a letter to Florida health officials in April saying the agency will work with the state to approve a waiver by June 30. The agency stressed Florida's plan must address concerns about patient care, transparency and accountability under the pilot program.
CMS officials said nearly half of the 200,000 patients enrolled in the pilot were dropped from at least one plan, which has disrupted their medical care. Several providers dropped out of the pilot program saying they couldn't make a profit.