Three years ago the Florida legislature began pushing for privatization of Medicaid. Even after a pilot program revealed many problems, the federal government has given final approval on the plan, imposing conditions that must be met, including a requirement that 85 percent of premiums must be spent on patient care. The new plan, called Managed Medical Assistance, operates much like any HMO except the state pays the premium, typically for a woman between 14 and 54 $300-$428. Before enrolling in a plan one must check to make sure that the physicians that they wish to use are included in the network. The participating insurers sign a contract with the state agreeing to provide medical services for a five-year period and there are minimum network sizes and limitations on changes. If changes are made the provider is expected to pay for any appointments or treatments required during the transition period, To date the transition is complete in 54 of 67 counties.
Florida is the first state to privatize Medicaid on this scale.
Florida is not the first state to make the move to this type of Medicaid privatization but it is the first to do it on this scale, including long term care patients, a very high risk and high cost group. It is this group that has caused some critics to question the wisdom of handing the care of this population over to a for profit organization and ask if there will be sufficient oversight of these private insurers. The idea behind the program is that by keeping people healthy in the first place and heading off problems before they advance to a stage more difficult to treat will cost less and therefore save the state money and at the same time allow them to stabilize and better predict the annual costs. At the same time the for profit company is incentivized to keep the patient healthy for the same reason, the less it costs to maintain the health of the patient the higher the profit for the company.
Is privatized Medicaid too good to be true?
This has resulted in the private insurers offering coverages not available on the old Medicaid plan such as adult dental coverage as well as hearing and vision coverage with some plans even offering coverage for art or equine therapy. It’s so new we really don’t know,” Babette Bach, a Sarasota elder law attorney told the Sarasota Herald Tribune:
“The significance is that the state is paying an insurance premium for everybody on Medicaid. They’ve totally privatized it. Is it going to save the state any money? I don’t think it is.”
Bach did have some positive things to say about the new program as opposed to the old Medicaid program, “There are more covered services,” she said. “That’s definitely good for people out in the community. But people in skilled nursing don’t use a lot of these services.”
“We’re all trying to get a handle on the true financial costs of what the state is doing.”
Only time will tell if this is a success or just another scam by Florida Republicans to divert more government funds to private for profit companies.