Florida: Florida eyes managed care

Sunday, February 27, 2011

TALLAHASSEE, Fla. - Florida's next legislative session doesn't start until this month, but lawmakers were already making plans to overhaul the state's Medicaid program--a move that some industry stakeholders say could shut HME providers out of the program.

In November, lawmakers passed a resolution to try and expand a 2006 reform plan that would move all Medicaid beneficiaries into managed care plans. Currently, beneficiaries in five counties are enrolled in managed care. The industry beat back a similar proposal in 2010

"They are moving this forward in an aggressive manner," said Sean Schwinghammer, executive director of the Florida Association of Home Care Suppliers (FAHCS). "Newly elected officials who hadn't even served a full day, with no background on any of the healthcare issues, were voting to support a waiver they hadn't read."

Schwinghammer says most managed care plans work with limited provider networks, which in turn limits beneficiary access and choice.

"I don't care if it's diabetic or enteral or oxygen," he said. "HMOs are not known for having the best service."

Provider Jose Linares begs to differ. He says his company services thousands of Medicaid beneficiaries through managed care plans.

"We provide 24-hour care and have technicians out and about handling hospital discharges or delivering care," said Linares, senior vice president of operations for Miami Lakes-based All-Med Services. "They are treated the same as any other patient."

With continued budget pressures and an expected flood of new beneficiaries to Medicaid rolls under the Affordable Care Act, it's not surprising that the issue is back on the agenda, Linares said.

"They need to get some control over the system," he said. "This is a great way for the government or another entity to have a fixed cost with a provider that they can hold accountable and not be chasing around multiple providers."

But Schwinghammer fears that lawmakers are only looking at short-term savings.

"Patients who can't get service, have no other recourse but the hospital," he said. "The cost of one day at the hospital will cost the same as two years worth of oxygen in the home and the basic service we provide now. It's a huge negative."