Governor’s Medicaid
Modernization Proposal
A Position Paper of the Florida Catholic Conference
THE PROPOSAL
On January 11, Governor Bush released his “Florida Medicaid
Modernization Proposal”. It is considered a “conceptual framework” that
will guide public policy reform discussions for the program that serves
2.2 million poor or otherwise vulnerable Floridians. The plan relies on
competing private insurers, HMOs, provider-sponsored networks (PSNs) and
other community-based service providers offering a variety of health plans
to Medicaid clients, with Medicaid paying a per-person premium based on a
patient’s expected need. This will make the program look more like
private insurance, with a state re-insurance fund for catastrophic care.
Legislative activity and federal approval of a Medicaid waiver will be
required before enactment.
CATHOLIC
HEALTHCARE ON BROADER REFORM
Catholic
health care leaders share the urgent sense that health care reform is
needed in order to ensure that a reasonable standard of healthcare is
available to all persons and to address existing problems in the delivery
system. Medicaid reform can clearly benefit the state, while broader
reforms remain necessary. The Florida Catholic Conference offers comments
below to advance dialogue on the proposal, to promote the common good, and
to safeguard the interests of those the program serves.
PRELIMINARY RECOMMENDATIONS FOR FLORIDA
MEDICAID REFORM
Quality of Service – Avoidance of Benefit Erosion
While removing requirements as to scope amount and duration
of services does provide flexibility that will differentiate plans in the
marketplace, several concerns arise: 1) some level of consumer protection
is lost, 2) some beneficiaries are likely to have difficulty selecting
plans that appropriately meet their needs, 3) policy makers will have
greater difficulty monitoring utilization of service and health status,
i.e., too many decisions over access to care will be made by too many
parties with the potential for too little public discussion, and 4) as
funding pressures mount, benefits to vulnerable persons could erode. We
recommend some benefit “floor” be established that all participating plans
must offer.
Possible
Problem: Further Fragmentation of Medicaid
Governmental centralization of Medicaid has been criticized
in the proposal, without acknowledging that it allows open policy debate,
increased oversight and coordination to the program than might otherwise
take place. Efforts must be undertaken to ensure that a program that is
already fragmented and difficult to manage does not become more so.
Children’s Health Care
While children comprise a large portion of the Medicaid
population, they utilize relatively few resources. As highlighted above,
there is concern over the erosion of the benefit package (that private
plans must also offer) in the proposed plan. Efforts should be made to
ensure that children in the same family participate in the same plans, and
that children can continue to be seen by physicians who have treated them
satisfactorily over time.
Managed Care – Protections Needed
In
addition to concern over losing special payments by increasing the role of
managed care in Medicaid, there is more fundamental concern that the
for-profit orientation of Medicaid HMOs will have a negative effect on
beneficiaries’ access to care over the long term. While managed care
companies have played a significant role in the delivery of health care
and managing costs, their for-profit motivation must be merged with a
competing interest in providing reasonable care to all beneficiaries. We
support establishing a meaningful rating system of all plans – including
PSNs – that will ensure a reasonably informed public. This will be
critical as the Governor’s proposal develops.
Long
Term Care
Florida is already among the most efficient states when it
comes to funding long-term care. In terms of rankings for beds per
thousand elderly and per capita elderly expenditures, Florida ranks very
near the bottom of all states. However, Florida does not rank well in
terms of relative spending on alternatives to long-term care and
community-based services. The long-term care system is not sustainable
without additional funding. While Florida has made gains in quality in
recent years, these will not be maintained if the percentage of nursing
homes whose reimbursement fails to cover costs of care continues to rise.
Access to
a Reasonable Standard of Health Care: Dignity Demands it for All
The proposed policy relies on market forces and economic
theory, which are highly complex and are rightfully part of the dialogue.
However, much of the current policy debate overlooks a fundamental
Catholic moral concern that a reasonable standard of health care is
something to which people must have access. Our current state health
policies leave 3.2 million people uninsured. Addressing this problem –
not just Medicaid spending growth – is one of our central goals. This
would bring stability to the delivery system, address some of the present
injustices in the system such as disparities in health status attributable
to race and income, and eliminate much of the volatility that having a
large uninsured population introduces to the delivery system.
Consensus
on “Care for All” and Long-Term Effort Required
There needs to be a long-term effort to build consensus and
commitment among all stakeholders in the health care delivery system to
overcome the identified problems in the health delivery system. We
commend the Governor for calling for the need for Medicaid reform, and for
the past work of the Task Force on Access to Affordable Health Insurance.
Rather than focusing on Medicaid alone – which is clearly a critical
component of the delivery system that serves all Floridians focused on the
poor and vulnerable – we urge consensus on ensuring adequate care for all
Floridians. Consensus among all stakeholders – including the federal
government – will be necessary to enact meaningful reforms.
March 1, 2005
