Stop HMO Medicaid Takeover

Dear County Medical Society and Specialty Society Executives,

As feared, the Senate Health and Human Services Appropriations Committee has introduced a proposal that would require Medicaid recipients in 19 counties to start enrolling in managed care plans during the next year. This proposal would extend the HMO takeover of the Medicaid program to the rest of the state within 18 months. This proposal will most likely be included in the HHS budget recommendations being made this week.

IF THE MEDIPASS PROGRAM OR FEE FOR SERVICE IN MEDICAID IS TO SURVIVE, IT IS IMPERATIVE THAT YOUR MEMBERS CONTACT THEIR SENATOR AND REPRESENTATIVE NOW AND ASK THEM TO STOP THE HMO MEDICAID TAKEOVER.

Please ask your members to use the following link to contact their legislators and let them know that there is are better ways to save money in the Medicaid program. Feel free to use the talking points provided below. The White Paper produced by the FMA Policy Center is attached .

TALKING POINTS

1. It is premature and inappropriate to call for the expansion of mandatory managed care in Florida before evaluating data from the existing Medicaid Reform pilot program to determine cost savings and the impact on access to care.
2. Reports from the University of Florida and OPPAGA warn that although cost savings are possible under Medicaid Reform, these savings may come at the expense of access to care. Thorough data analysis is necessary to ensure that this has not been the case in Florida, and this will not be completed in time for a policy change during the 2010 Legislative Session.
3. States that have implemented widespread mandatory MMC have experienced serious problems in terms of financial viability, provider networks and access to care.
4. MMC arrangements can result in a greater unmet need for care, particularly when the managed care organization is a for-profit entity.
5. Cost savings are not always achieved via MMC. Evidence suggests that Medicaid spending has grown at about the same rate in states with and without MMC arrangements.
6. Where cost savings have been demonstrated under MMC, they are generally the result of greater coordination of care and hospital diversion efforts. These program features are not exclusive to managed care arrangements and can be implemented just as successfully through alternative models.
7. Alternatives to MMC have demonstrated equal or greater ability to curb Medicaid cost increases. In particular, the "medical home" model has been proven to lower Medicaid spending while increasing access to care for beneficiaries. The medical home model can be implemented through various arrangements and does not require the involvement of managed care.
8. Increased reimbursement rates for Medicaid providers can result in cost savings to the state. Common to the nation's most successful Medicaid demonstrations is adequate reimbursement for providers. Without viable fees, Medicaid programs will suffer from diminished access to care for enrollees. Other states have reported cost savings under the medical home model while simultaneously increasing provider reimbursement rates. This is because of better coordination of care, the avoidance of costlier care in hospital settings and better detection of fraud and abuse.
9. The expansion of MMC also may diminish access to care for the uninsured. Safety-net providers face more financial risk under MMC contracts, and community health centers with MMC serve fewer uninsured patients than counterpart centers without MMC.[i] In contrast, the medical home model, when implemented to include safety-net providers within community networks, provides greater opportunity for increased care to Medicaid and uninsured populations.

Jeff

Jeffery M. Scott, Esq.
General Counsel, Senior Director of Governmental Affairs
Florida Medical Association
850 224-6496
jscott@medone.org

Last Revision: April 22, 2010