A big wave of managed care is heading for the Sunshine State. Late last week, the Florida Legislature voted for a massive overhaul of...

A big wave of managed care is heading for the Sunshine State.

Late last week, the Florida Legislature voted for a massive overhaul of the state’s Medicaid system. It would move millions of poor people into HMOs and other managed care plans to save money and improve health services, The New York Times reported. The shift would begin in July 2012.

Georgia, meanwhile, is ramping up a review its own managed care program, which covers more than 1 million Medicaid and PeachCare for Kids beneficiaries. The commissioner of the agency that runs Medicaid in the state, David Cook, has said he wants to take a comprehensive look at alternatives to the HMO-like structure that was instituted by former Gov. Sonny Perdue.

The state currently pays the three “care management organizations’’ a total of more than $2.5 billion a year to serve Medicaid and PeachCare.

Georgia’s planning effort will coincide with the run-up to a huge expansion of the Medicaid program, which would add more than 600,000 Georgia residents to the program if health reform is fully implemented, beginning in 2014.

The federal government regularly pays about two-thirds of the cost of Medicaid in Georgia, but would pay all of the tab for the first three years of expansion. Medicaid is a $6 billion-a-year program in Georgia, counting federal money.

Joann Yoon of consumer group Voices for Georgia’s Children said Monday that Georgia’s review of its Medicaid program and those of other states would come at a good time, with the 2014 expansion coming.

Georgia’s review should focus on access to services and quality of care, as well as cost savings, she said. Medicaid and PeachCare beneficiaries have run into administrative hurdles and problems in access to medical providers, she added.

“Some of my caution and concern is whether there will be meaningful input from consumer advocates and consumers’’ in the state’s review, said Yoon, who is associate policy director for child health at Voices.

The current care management organizations have not delivered the expected amount of savings, Yoon said, citing a state audit.

Florida’s newly passed Medicaid proposal has strong Republican backing. Rep. Rob Schenck, a Republican House sponsor of the legislation in Florida, said, “We get to save billions of dollars, and we get to deliver better health care,’’ the News Service of Florida reported.

The Florida bill has several innovative features. The state would share in insurers’ profits if they exceed 5 percent. The legislation also would include a $10 monthly premium for patients, and a charge of $100 if they went to an emergency room without an emergency.

Those fees may trigger problems with the federal government, which must approve major changes to a state’s Medicaid program.

Florida Democrats said it’s unfair to charge poor patients fees. “You know these people don’t have money,’’ state Rep. Charles Chestnut told the News Service of Florida.

The legislation would pay higher rates to doctors and limit what they would pay out in malpractice damages.

Gov. Rick Scott, a former health care entrepreneur, supports the Medicaid legislation.

Florida, though, would not necessarily be the model that Georgia would pursue.

Medical provider groups in Georgia recently have expressed interest in North Carolina’s Medicaid model.

The Medicaid program there uses a ‘’medical home’’ model. The state is divided into 14 nonprofit, doctor-directed regional care networks. Hundreds of care managers help people stay healthy, visiting them in their homes and helping keep them out of emergency rooms. Physician panels decide quality parameters.

North Carolina says it has saved millions of dollars annually with its Community Care program.

And at a recent board meeting of the Department of Community Health, Commissioner Cook expressed interest in looking at how Indiana’s program works.

Healthy Indiana has a benefits package modeled after a high-deductible, health savings account insurance plan. It covers Medicaid beneficiaries and also low-income uninsured adults.

Preventive care is covered free. But there’s also a charge of $3 to $25 for an ER visit. Here’s a snapshot of Healthy Indiana by the Kaiser Commission on Medicaid and the Uninsured.

Georgia is expected to hire a consulting firm to study different models.

At the end of the process, Georgia could decide to stick with its current care management organization program, which is nearly five years old.

Or it could follow another path.

Either way, the state’s medical providers, lawmakers, and consumer advocates will be watching the process with intense interest.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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