Florida Medicaid Providers Get Friday Double-Punch

TALLAHASSEE — On the last day of its session Friday,
Florida’s legislature passed a comprehensive reform plan for
Medicaid that moves most of the state’s beneficiaries into managed
care.

Lawmakers have long 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 $20
billion a year.

But the cost elsewhere in the system could be huge, according to
Sean Schwinghammer, executive director of the Florida Alliance of
Home Care Services. Under the plan, the state will be divided into
11 regions with HMOs and provider-service networks competing for
contracts in each area. Many HME companies currently providing
equipment and services to Medicaid beneficiaries could lose that
business, he said.

A final appropriations bill approved Friday also moves the
Sunshine State to a single-source supplier for all Medicaid
incontinence supplies.

Schwinghammer called that move an “inappropriate, sweetheart
deal” that amounts to lost incontinence supply business for HME
providers in the state.

According to Schwinghammer, the decision is the result of a
major out-of-state company’s long-term efforts to corner the market
by advocating a competitive bid system that only it can likely win.
As one feature of a massive $60 billion appropriations bill, the
new system would shave 20 percent off current incontinence supply
costs. However, FAHCS officials point out that the state
implemented a fee schedule that already assured a 20 percent
cut.

“This bill requires groups to use whatever company wins the bid
and not to use any other,” said Schwinghammer. “It controls and
creates a monopoly for the market and the new managed care systems
that have yet to be fully crafted. It is detrimental and
long-term.”

The setback is part of a fight that goes back several years.
Joan Cross, executive director of the Florida Association of
Medical Equipment Services, believes the difference this time came
down to clout and economics.

“About five years ago we hired a high-priced lobbyist to get it
stopped, but this year nobody could afford it,” said Cross. “The
government wants to reduce costs, and the state is in trouble like
everybody else. Now a provider from Michigan is likely going to get
Florida’s money. They talk about saving jobs, then they do this
kind of thing.”

The owner of Miami-based Health Medical Equipment views the
legislature’s vote as yet another salvo in the assault against
small providers.

“We are a small mom-and-pop store, but the government is looking
at working with just one provider,” lamented Ivonne Gonzalez,
owner, Health Medical Equipment. “Our revenues will go down and
employees will lose their jobs. Every time they decide to go with
one provider, just like the HMOs do, that could close us down.”

With a dozen employees and 18 years as a home care provider,
Gonzalez relies on all elements of her business to meet payroll. At
this point, even a small hit causes pain.

“It all adds to the pot to make our business work,” said
Gonzalez. “If everyone keeps taking away from us, it hurts us but
it also hurts patients. With the way things are changing in Florida
— more cuts and more managed care — where are we going
to go?”