WellCare Pulling Out Of Florida Medicaid Pilot In Two Counties, Citing Too-Low Reimbursements

Main Category: Medicare / Medicaid / SCHIP
Article Date: 09 Feb 2009 - 2:00 PDT

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WellCare on Wednesday announced that it will end its participation in Florida's Medicaid pilot program in Duval and Broward counties, effective May 1, the Florida Times-Union reports (Larrabee, Florida Times-Union, 2/5). Under the pilot program, which covers most Medicaid beneficiaries in five Florida counties, the state pays private insurers a set amount for covering a specific number of residents and the companies determine what benefits and coverage network they will offer. An Associated Press analysis "showed doctors are dropping out of the program and there is little evidence the program is saving money," the AP/Miami Herald reports. In addition, rates paid to insurers have been reduced as a result of a $2.5 billion deficit-reduction package signed last week by Gov. Charlie Crist (R) (Kennedy, AP/Miami Herald, 2/4).

WellCare in a statement said its decision to leave the pilot program in Broward and Duval counties "is a result of recent state budget cuts that make it economically unfeasible to continue offering members sufficient access to quality health services in those programs" (Caputo, Miami Herald, 2/5). The action will affect more than 78,000 beneficiaries in the two counties, where WellCare has a market share of about 41% through its HealthEase and Staywell plans (Jordan Sexton/Gentry, Florida Health News, 2/4). WellCare President and CEO Heath Schiesser in a statement said, "We are disappointed that we must take this action, but operating in these programs is unsustainable."

A notification will be sent out 60 days before WellCare withdraws from the program to allow beneficiaries to choose a new plan. Florida Agency for Health Care Administration spokesperson Fernando Senra said beneficiaries enrolled in WellCare plans will "continue to receive all Medicaid-covered services without interruption," adding, "The agency is working closely with WellCare on the transition plan that will ensure service provision and continuity of care" (AP/Miami Herald, 2/4). AHCA Secretary Holly Benson said, "We've had good meetings with the other plans in the area and are optimistic that they can continue to meet the needs of our beneficiaries," adding, "And we continue to approve other plans that may be interested in coming to Duval" (Sexton, Florida Health News, 2/5).

Critics of the pilot project called on the state to end the program or at least abandon plans to expand it. Joan Alker, a Georgetown University researcher, said, "There are a lot warning signs and this disruption only makes those signs clearer." State consultant R. Paul Duncan of the University of Florida said it is "not clear" whether the other HMOs have an adequate number of providers to handle former WellCare beneficiaries (LaMendola, South Florida Sun-Sentinel, 2/6). State Rep. Mary Brandenburg (D) said the pilot project "may have been a good idea [when it began in 2006], but it hasn't worked" (Florida Health News, 2/5).

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