State Medicaid Programs

Posted on June 3, 2011 by townsend

• Florida governor signs historic Medicaid bill, By Kelli Kennedy (AP), June 2, 2011, Miami Herald: “Florida Gov. Rick Scott signed two historic Medicaid bills Thursday, placing the health care of nearly 3 million Florida residents into the hands of for-profit companies and hospital networks. Lawmakers said the program was overwhelming the state budget and needed to be privatized to rein in costs and improve patient care. Critics fear the bills build on a flawed five-county experiment where patients struggled to access specialists and doctors complained the treatments they prescribed were frequently denied. State Sen. Joe Negron, who spearheaded the overhaul, said leaders have learned from the pilot program’s shortcomings and it now includes increased oversight and more stringent penalties, including fining providers up to $500,000 if they drop out. The measures also increase doctors’ reimbursement rates and limits malpractice lawsuits for Medicaid patients in hopes of increasing doctor participation in the program. The bills (HB 7107 and HB 7109) also require providers to generate a 5 percent savings the first year, which could save the state about $1 billion…”
• Medicaid managed care expands in California as State adds 1 million seniors and disabled, By Christopher Weaver, June 1, 2011, Kaiser Health News: “More than one million of California’s older and disabled population will receive a birthday gift this year that they may not have asked for: membership in a state-sponsored managed-care plan. They’re now covered by Medicaid, the state-federal program for the poor that is called Medi-Cal in California. Starting this month, California is requiring them to join a state-paid Medicaid managed-care plan, which will coordinate their services and direct them to particular doctors and hospitals. Each person affected by the change must enroll by the end of the month in which their birthday falls. This abrupt change in policy reflects a broadening consensus in the state that managed care – which in California is offered both by for-profit health plans and local, public plans – is more efficient, both for patients and the state…”
• Utah unveils ambitious overhaul of Medicaid, By Kirsten Stewart, June 1, 2011, Salt Lake Tribune: “Utah health officials on Wednesday unveiled a 91-page blueprint for overhauling the state’s Medicaid program, billing it as way to preserve the low-income health safety net. The plan envisions steering Medicaid patients into managed care networks, or Accountable Care Organizations (ACOs), which would be paid lump monthly sums per patient. If an ACO spends more than allotted for care and prescription drugs, it absorbs the loss. If it spends less, it gets a share of the leftovers — similar to old HMOs of the ’90s. HMOs were accused of cutting costs by denying care, often pitting insurers against doctors. But in ACOs, doctors will work with their patients, ordering treatments under strong incentives to improve care and cut costs, said the plan’s architect, Sen. Dan Liljenquist, R-Bountiful. The current fee-for-service model of paying doctors and hospitals directly is a ‘free pass,’ said Liljenquist, and encourages providers to do more tests and conduct more procedures than necessary. ‘That expense is overwhelming us,’ he said…”