2007 Industry Outlook
Florida's experiment to allocate Medicaid dollars more efficiently will get plenty of scrutiny.
The state pays the HMOs and PSNs a risk-adjusted premium for each Medicaid enrollee based on the age, sex and health status of the enrollee. "We have a defined investment going in," says Christa Calamas, secretary of the Florida Agency for Health Care Administration (AHCA).
The participants in the pilot programs can qualify for "enhanced benefits" by taking steps to stay healthier -- entering smoking cessation programs or disease management plans if they have chronic illnesses, for example, and undergoing routine mammogram screenings.
The participants can earn voucher credits, up to $125 annually, which can be used to buy over-the-counter medications and medical products.
How much the program will reduce the growth of Florida's Medicaid budget in the long term is unclear, but in its application for the waiver, Florida agreed that the federal government wouldn't have to increase its share of Florida's annual Medicaid budget by more than 8% per person.
"I think that people assume that this is about costs," says Calamas. Indeed, one of the first points made in the state's Medicaid waiver application is the dramatic growth of Florida's Medicaid program as a percentage of the overall budget.
But the waiver application also focuses on letting individuals make more of their own healthcare decisions -- a point that Calamas is quick to emphasize. The primary goal, she says, is to add choice, flexibility and a network in which care is coordinated. "We are replacing the outdated system that we have today."
Advocates for children and low-income Floridians as well as healthcare providers, state lawmakers and AHCA officials are watching the pilot programs carefully. Joan Alker, a senior researcher with Georgetown University's Health Policy Institute, says one question to ask is whether all the benefit packages are generous or whether generous benefits in some benefit categories are offset by restrictive benefits in others. The University of Florida's Florida Center for Medicaid and the Uninsured, the Florida Legislature's Office of Program Policy Analysis and Government Accountability and the Georgetown institute (working under contract from the Jacksonville-based Jessie Ball duPont Fund) will each evaluate the pilot programs.
Additional pilot programs in Baker, Clay and Nassau counties will be added this summer, but the Legislature must authorize any further expansion of the program.