Despite continued problems with Medicaid reform, the Agency for Health Care Administration (AHCA) has identified 19 new counties as possible sites for expansion.

In a Feb. 17 presentation to the Senate Ways & Means Committee, AHCA Secretary Tom Arnold told lawmakers that 16 counties already have the infrastructure with two or more existing managed care plans  (read more here).

Those counties are: Miami-Dade, Orange, Hillsborough, Pinellas, Brevard, Citrus, Hernando, Jefferson, Lake, Madison, Manatee, Osceola, Pasco, Polk, Seminole and Wakulla. 

Another three counties — Gadsden, Liberty and Palm Beach — also have at least two managed-care plans but currently lack the capacity to accept additional enrollees, according to Arnold.

Currently, the Medicaid reform pilot project is underway in five counties: Broward, Duval, Baker, Clay and Nassau.

A University of Florida study commissioned by AHCA indicates that Medicaid reform has saved money, but the findings fail to take into account many factors, such as the cost of providing  ”choice counselors”  that are supposed to assist Medicaid recipients with choosing a health plan. But whether Medicaid reform has been a success or failure remains unanswered. The lead researcher of the UF study told legislative committees recently that Medicaid reform is “not the kind of panacea that would solve all of Medicaid’s problems in one fell swoop, nor is it the kind of train wreck that some people feared.”

Findings from Georgetown University’s Health Policy Institute indicate otherwise. According to their surveys, the pool of physicians and specialists has declined in the Medicaid reform health plans; excessive paperwork and service authorizations create barriers to medical care; reform plans have actually scaled back patient benefits including prescriptions (read their reports here; see more information at www.floridachain.org/medicaid).

For the past three years, Gov. Charlie Crist has stated his opposition to expanding Medicaid reform. But he recently reversed course and said he is “open” to the idea of Medicaid reform, so long as it’s not limited to managed care plans. Senate President Jeff Atwater told the Miami Herald that he supports expansion as well because it “has dealt with escalating prices and changed behaviors by setting up patients with a primary care doctor to prevent unnecessary emergency room visits.”

Industry groups including hospitals and community health centers have pitched lawmakers on ways to change the entire Medicaid program, irrespective of Medicaid reform. The hospital industry, for example, envisions an approach that involves more hospital-based provider service networks (Children’s Medical Service is an example of such a network).

The Florida Association of Health Plans has developed its own proposal for an overhaul. It calls for all Medicaid beneficiaries to be enrolled in managed care plans, which would include long-term care such as nursing homes. 

Meanwhile, several lawmakers and advocacy groups are pushing for a “medical home” model of care to replace Medicaid reform. (read more here).

Alliance members: check the Members Only section for weekly legislative developments on these issues.