Last week, in response to a lawsuit over access to specialized children’s health care services, a judge halted use of the screening tool used by the Department of Health to identify children who meet or do not meet eligibility for Children’s Medical Services Network enrollment.
In response, the Florida Agency for Health Care Administration is scrambling to devise an interim method of screening while the rulemaking process proceeds. This turn of events demonstrates the overall Statewide Medicaid Managed Care plan was rolled out too hastily for the necessary network preparations.
The Statewide Medicaid Managed Care program was based on the five-county pilot that performed poorly in multiple analyses of access, quality, and continuity of care, without demonstrating real cost savings. We were fortunate that the federal government required Florida to redesign the program with several consumer protections that were missing from the pilot demonstration. Among the changes that were required was prohibiting managed care companies from designing the benefit packages or imposing limits on benefits.
These are important protections, but, one year following the statewide implementation, we are waiting for data to tell us how consumers’ access to quality care has fared under this initiative. We have evidence that the cost savings predicted haven’t materialized through the contracted managed care plans’ reports of $542 million losses and subsequent 7.7 percent capitation rate increase granted by the state for the second year.
The Florida Department of Health, the federal government, and all health care consumers should monitor the outcomes of all facets of the Medicaid Managed Care program, paying special attention to the plans aimed at highly vulnerable populations.
Scott Darius, Advocacy Director for Florida CHAIN