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?"
