Florida Should Delay Medicaid Pilot Project Expansion, Report Says

Main Category: Medicare / Medicaid / SCHIP
Article Date: 19 Oct 2007 - 9:00 PDT

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Florida should hold off on expanding a Medicaid pilot program until problems with the program are fixed, according to a report by the state's Medicaid inspector general, the South Florida Sun-Sentinel reports. The pilot program covers residents in five counties and was designed to save billions of dollars and provide better care for state's 2.3 million Medicaid beneficiaries by moving them to private coverage.

According to the report -- the first to evaluate the year-old program -- low-income beneficiaries have had a difficult time selecting the best plan for them under the HMO-style coverage, forcing some to switch doctors. The report found four major problems with the program:

• Some beneficiaries with complex illnesses used the maximum allowed for drug coverage and were left uncovered;
  
  
• 12 of 17 insurers made it difficult to determine which medications were covered and had errors on their doctor lists, and beneficiaries had problems picking the most appropriate plan;
  
  
• Beneficiaries had trouble finding specialists who accepted the coverage, a common problem with regular Medicaid; and
  
  
• Although participant complaints were down, it was partly due to the state having no system in place to receive complaints.
  

Based on the analysis, "Further expansion of Medicaid reform should be delayed until such time as those improvements are met" and the program's health care quality can be analyzed, Inspector General Linda Keen wrote.

Miriam Harmatz, an attorney for Florida Legal Services, said, "These are serious problems. This is from their own people, talking to their own people," adding, "The agency has got to make sure these issues are addressed ... before we go forward." Under the original plan, the program could be expanded statewide by the end of 2008; however, Andrew Agwunobi, secretary of the state Agency for Health Care Administration, on Wednesday said he has not decided whether to delay the expansion. "We need to evaluate a lot more information," he said (LaMendola, South Florida Sun-Sentinel, 10/17).

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