A little-known incentive buried in Florida's new Medicaid reform law will reward health plans for cutting numbers of seniors in nursing homes, several speakers said during a highly charged hearing on the law Tuesday.
Calling it the "granny dumping bonus," elder law attorney Ellen Morris warned that the law could result in eviction of seniors from nursing home care after 2012.
Morris, who practices in West Palm Beach and Boca Raton, is the legislative chair of The Florida Bar's elder law section.
"Florida is poised to put thousands of long term care patients out into the cold without services," she predicted. "There is no verifiable system to ensure that vulnerable elders are not evicted inappropriately."
More than 200 people packed the hearing at the Airport Hilton, intended to inform Agency for Health Care Administration officials as they implement the overhaul and try to win approval from federal authorities.
At its core, the plan requires most of the state's 3 million Medicaid enrollees to join private health plans after July 1, 2012. While the developmentally disabled, those in juvenile justice and mental health institutions are excluded from the privatization effort, seniors in nursing homes are not.
State Rep. Joe Negron, R-Stuart, who helped write the law, said he toured the state listening to Medicaid recipients' and providers' concerns last summer. He studied how other states are grappling with rising Medicaid and long-term care costs as well, and he's convinced that the incentives for moving seniors into a home care setting will benefit everyone, cutting costs for taxpayers and providing seniors with dignity.
"I would never support a policy that discouraged nursing home care for seniors who need it, but the reality is that seniors want to have more home- and community-based options," said Negron, who chaired the Senate Health and Human Services budget committee. He said seniors living in nursing homes won't be included in the privatization.
Morris said the new law does away with longstanding, effective rules on who has recovered enough to be discharged from a nursing home, and replaces them with vague terms insurance companies will ultimately decide.
"Managed care companies will be paid bonuses for evicting seniors from nursing homes," she predicted.
"I don't think that is a legitimate criticism, and it's kind of a scare tactic," Negron responded in an interview after the meeting.
Florida, like most states, has been struggling to cope with the rising costs of its Medicaid low-income health safety net, as the weak economy drags on, and increasing numbers of Floridians qualify for benefits.
Enrollment has increased by about 50 percent in four years, from 2.1 million in 2007 to more than 3 million this year. For the first time, Florida's Medicaid spending for 2011 is going to exceed education spending, at more than $20 billion, state officials said Tuesday.
Because Medicaid is a joint state-federal plan paid mostly by the U.S. government, Florida's Medicaid privatization experiment cannot proceed without an OK from the U.S. Centers for Medicare & Medicaid Services.
"Given the imminent irreparable harm and the inadequate protection for Florida's elderly who need long-term care, they must be excluded from this experiment, and we will be fighting to make sure that CMS denies this request," Morris said.
Negron said the federal approval process will be one of give and take and negotiating.
In April CMS officials said they wanted to see a requirement that insurers spend a set amount on benefits as opposed to overhead and profits. The Legislature instead created a profit sharing system, that takes a share of companies' profits if they exceed certain overhead and profit percentages. Texas is pursuing similar policy.
Whether that and the nursing home reduction incentives pass muster with CMS remains to be seen.
" I will keep monitoring it and I am in contact with AHCA on a regular basis," Negron said. "Washington is broke. They know the states have financial pressures. I have seen them approve waivers that no one thought would get approved."
The speakers Tuesday raised a litany of other worries, as well.
Amy Silverman, a Delray Beach-based Medicaid mental health care recipient, experienced life on Medicaid HMOs in Broward County's pilot program, and said it became impossible to stay with the doctors who knew her or obtain the medications that worked for her condition.
"Doctors dropped out for lack of payment, prescriptions would not be filled by plans," she said. "Most of the original plans dropped out, so I was forced to change plans over, and over, and over."
Other speakers highlighted an amendment that allows some Medicaid health plans to refuse to cover family planning services if they have religious or moral objections. Such services would include contraception services.
Speaking for Planned Parenthood, Wellington-based Loren Londner predicted that unplanned and premature births will rise. More than one-third of all births in the state are paid for by Medicaid, she said. "If this legislation is about saving babies, then what the heck are we doing?" she asked.