Overhaul of Medicaid Is Enacted in Florida

Gov. Jeb Bush signed into law Friday the nation’s most sweeping overhaul of Medicaid, a move that would shift many of Florida’s recipients into private managed care to help curb the rising costs of healthcare for the poor.

Bush called the legislation “the single biggest change and the boldest reform that any state has embarked on” for Medicaid.

“I am absolutely confident that this reform will yield better healthcare results for Florida’s most vulnerable citizens and create more predictability in management of our costs,” he said.

Under the plan, Medicaid recipients in some counties will choose a managed-care group to coordinate their care. The government will pay a premium -- based on the person’s health -- to the group. Companies will get more money for sicker patients.

The changes will take effect in Broward and Duval counties, and will be phased in statewide later. Several states have experimented with moving Medicaid patients into managed-care plans, but none has overhauled an entire system this way.

The Legislature approved the plan this month over the objection of some advocates for the more than 2 million poor, elderly and disabled Floridians covered by the $16-billion Medicaid program. Many advocates fear that the state’s sickest people will fall through the cracks.

“In a year when they just announced that they have $3 billion in extra revenue coming in, it seems rather tragic that we’re launching a massive experiment with people’s lives,” said Karen Woodall, who represents a coalition of advocacy groups.

More than half of Floridians covered by Medicaid are already in some type of managed-care plan or health network. The difference is that the state controls their treatment, whereas under the new program the state will mandate coverage for certain illnesses, but HMOs will decide the amount, duration and scope of treatments.

To ease fears that HMOs will not accept patients with costly illnesses, HMOs that take sicker people will be paid higher premiums. If they can treat the patients for less than the premium, they keep the difference.