Medicaid Reform: A Failed Experiment

Florida CHAINNovember 12, 2008

WHAT is Medicaid Reform?

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“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

• Complexity/confusion/administrative burden• 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

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• Broward• Duval • Baker• Clay • Nassau

WHERE Is Medicaid Reform?

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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• Georgetown University• University of Florida• OPPAGA• Health Advocates (Florida CHAIN, Florida

Legal Services, etc.)

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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.

Florida CHAIN

MEDIPASSMEDICAIDMANAGED

CARE

Erosion of Medipass = Expansion of Medicaid Managed Care

Medicaid Reform outside of the pilot counties?

HOW can I help?

• Educate yourself at www.floridachain.org• Join MRAC (Medicaid Reform Advocates

Coalition)• MRAC Listserv • Legislative Visits• Opinion Pieces• Get involved in Alternatives discussion

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