Monday, April 26, 2010

TALLAHASSEE, Fla. – The state has proposed transitioning most Medicaid beneficiaries into managed care plans, but such a move could shut HME providers out of the program, stakeholders say.

A recent Senate bill would expand a “reform” plan instituted in 2006 from five counties to 19 counties. Medicaid beneficiaries would be moved into managed care plans such as HMOs or public service networks (PSNs).

“It all comes down to money,” said Sean Schwinghammer, executive director of the Florida Association for Home Care Services (FAHCS). “We have to respond very aggressively against this.”

Schwinghammer says such a proposal would “destroy” the HME industry in the state by reducing the number of providers who could service Medicaid beneficiaries.

But not everyone is convinced the proposal would impact HME providers. Joan Cross, executive director of the Florida Association of Medical Equipment Suppliers (FAMES), pointed out that the bill doesn’t specifically mention durable medical equipment.

“I’ve got people looking at (the language),” she said.

Lawmakers are struggling to reduce costs, said healthcare attorney Lester Perling, a partner with Fort Lauderdale-based law firm Broad and Cassel.

“One idea that has been floated is mandatory HMO enrollment for all recipients,” he said. “That idea does not have much traction but it is very possible that the required use of managed care plans already implemented in some counties may be expanded to additional counties when the county has at least two qualifying managed care entities.”