Florida Medicaid Plan: ‘Titanic Running at Full Speed’

TALLAHASSEE, Fla. — Florida HME providers were working
furiously on Wednesday to combat proposed Medicaid legislation they
said would place beneficiaries in peril, cost thousands of jobs and
force hundreds of HME providers to close.

“It’s a massive Medicaid overhaul that was done surreptitiously
so people most involved in health care wouldn’t be able to respond
or be involved in the process,” charged Sean Schwinghammer,
executive director of the Florida Alliance of Home Care Services.
“We don’t believe it is best for patients or for business.”

Schwinghammer was even more blunt in his email appeal to FAHCS
members to contact their legislators: “This is the Titanic running
at full speed,” he wrote.

On Wednesday, even beneficiaries were calling legislators to
object to Florida House Bill 7223, which was introduced April 6.
The bill is expected to come up for a vote this afternoon,
Schwinghammer said.

Under the proposed legislation, virtually all Medicaid
beneficiaries would be moved into health maintenance organizations.
They currently have a choice of choosing their own providers or
belonging to an HMO.

The bill designates the state’s Medicaid authority, the Agency
for Health Care Administration, as the “single state agency to
administer the program; establishes the Medicaid program as a
statewide, integrated managed care program for all covered
services; authorizes [the] agency to apply for and implement
waivers; provides related and conforming provisions to
reorganization of Medicaid managed care.”

It’s the latest slam against the state’s HME providers. Last
year, Blue Cross/Blue
Shield dropped hundreds of providers from its program and
contracted instead with regional companies to provide care and
services to its beneficiaries.

Services ranging from HME and physical therapy to home nursing
care would be affected under the new proposal.

“There will be no exceptions, not for the elderly, incontinent
waiver patients, developmentally disabled patients, children,
etc.,” Schwinghammer said, noting that House leaders have
proclaimed no amendments or exemptions to the bill will be
accepted.

Legislators have said the plan would be a money-saver for the
state’s Medicaid program, which serves about 2.7 million and has
seen costs balloon to a staggering $19 billion a year. Legislative
analysts have said the state could realize a savings of 2 to 3
percent and even as much as 15 percent under the plan, which would
be phased in over five years.

The cost elsewhere in the system could be huge, however,
stakeholders said. Some 1,000 HME companies are involved in
providing equipment and services to Medicaid patients, according to
Schwinghammer, and the bulk of them would lose that business. Under
the plan, only three to 10 contracts would be awarded in each of
six geographic areas in the state.

The plan is designed to exclude small and medium-sized
businesses from participating in Medicaid, Schwinghammer said.
“Once the HMOs control it, they can limit it to whomever they want.
All the small companies that they don’t want in will be out,” he
said.

As many as 800 companies could close, and 10,000 jobs stand to
be lost, he said. “That’s a big deal in a state with the
second-to-highest unemployment in the country,” Schwinghammer
said.

“If you want to eliminate jobs, you’re going in the right
direction,” said Joan Cross, executive director of the Florida
Association of Medical Equipment Services. Cross said she
understands the massive Medicaid bill is crushing to the state, but
she objects to the method legislators have chosen to ease that
burden.

“They’re wanting to do it to save money and they’re saying that
everyone will have the same care,” said a skeptical Cross. “They
don’t have it clearly thought out. They think they are going to
have a team of doctors and hospitals, a disease management team, if
you will. They are going to put these groups together and manage
the care.”

The plan might sound good on paper, she said, but the reality is
“nobody wants to take these HMOs because they aren’t going to get
paid.”

Cross, a former HME provider, said she once had to drive to
Tampa, an hour away from her Bradenton company, to pick up a check
from an HMO. She was one of the lucky ones, she said; others have
had to go to court to get their rightful pay.

Both Cross and Schwinghammer questioned the wisdom of changing
the system so drastically without first waiting for the results of
an experimental project now going on in five counties (Broward,
Baker, Clay, Duval and Nassau). The state Senate has already
introduced legislation to extend the project to 19 more counties,
even though there is a class-action lawsuit against the pilot
program and, according to published reports, extensive complaints
from physicians and patients alike.

But state lawmakers have said they will not wait for an analysis
of the results.

“Everybody was taken by surprise,” Schwinghammer said, adding
that the bill “didn’t go through any committees and it was done
over Easter break. They were crafting it on Easter Sunday, so they
were really trying to rush this.”

If the House does pass the bill, he said, it will move on to the
state Senate. If it gets that far, “in all likelihood, it will
become law.”

FAHCS is urging Florida providers to call all elected leaders in
the state about the issue and email all representatives. For more
information, see www.fahcs.org.