Florida Should Delay Medicaid Pilot Project Expansion

Armen Hareyan's picture

Florida should hold off on expanding a Medicaid pilot program untilproblems with the program are fixed, according to a report by thestate's Medicaid inspector general, the South Florida Sun-Sentinelreports. The pilot program covers residents in five counties and wasdesigned to save billions of dollars and provide better care forstate's 2.3 million Medicaid beneficiaries by moving them to privatecoverage.


According to the report -- the first to evaluate theyear-old program -- low-income beneficiaries have had a difficult timeselecting the best plan for them under the HMO-style coverage, forcingsome to switch doctors. The report found four major problems with theprogram:

  • Some beneficiaries with complex illnesses used the maximum allowed for drug coverage and were left uncovered;
  • 12of 17 insurers made it difficult to determine which medications werecovered and had errors on their doctor lists, and beneficiaries hadproblems 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.

Basedon the analysis, "Further expansion of Medicaid reform should bedelayed until such time as those improvements are met" and theprogram's health care quality can be analyzed, Inspector General LindaKeen 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 surethese issues are addressed ... before we go forward." Under theoriginal plan, the program could be expanded statewide by the end of2008; 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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