State lawmakers advanced a bill aimed at overhauling Florida’s Medicaid managed-care system that the bill’s sponsors and policy experts say would increase access to care and promote much needed competition. The state’s Agency for Health Care Administration (AHCA) is gearing up to award new contracts to help administer Medicaid benefits to as many as 5 million eligible Florida citizens, including 6 in 10 Florida children.
Both the Florida House and Senate are considering changes to the existing managed care structure in the state that would have a significant impact on the contracting process which won’t begin until after lawmakers adjourn the 2022 legislative session. Between federal and state budget dollars, the total value of the state’s Medicaid managed care programs could approach $80 billion, but those dollars would be broken up into different regions governed by ACHA.
The House Health Care Appropriations Subcommittee approved HB 7047 yesterday by a vote of 10-5. The bill’s sponsor, State Rep. Sam Garrison, told the committee that the bill has a built-in mechanism to protect smaller providers and enhances competition by automatically diverting new enrollees away from providers who already have 45 percent or greater market share in a particular region.
“The goal is increasing competition and value to taxpayers, as well as the patient,” Garrison said. “The plan…redirects automatic enrollment to smaller plans whenever a plan has more than 45 percent of the region’s enrollees to ensure more robust competition.”
Policy experts say that the proposed changes are rooted in data analysis and improvements to health care outcomes.
But two lobbying groups for the hospital industry voiced their opposition Monday over proposed changes that could cause certain hospitals to lose supplemental payments if they don’t negotiate contracts with existing Medicaid managed care plans in their local region. Those contract disputes are typically mediated by ACHA.
Garrison, however, said his bill would reduce ACHA’s role as a referee in those situations.
“It’s the Agency for Health Care Administration, not the Agency for Health Care Dispute Resolution,” Garrison said. “So what we’re trying to do is get them out of the business of picking winners and losers and saying, ‘Yes, this is good faith,’ or ‘No, this is not good faith.’”
The bill also drew opposition from dentists. Joe Ann Hart, the top lobbyist for the Florida Dental Association, argued that the bill reduces incentives for dentists to treat Medicaid patients.
“The worst part about this that we don’t want to see is that it will create a disincentive for dentists to participate,” Hart told the House committee on Monday.
Critics also pointed out that if the House bill passes, it will be the third time the state made substantial changes to the program, causing substantial disruption to providers and the 4.2 million people they serve.
But Garrison defended the bill, saying the goal is “to provide the most comprehensive care for our dental patients at the lowest possible cost to the taxpayer, especially in situations where you have a Medicaid population, a number of them with unique health-care challenges that often time require a high level of integration between the dentist in the chair and the folks at the ER and the hospitals.”
“In my conversations with the folks on all sides of this debate,” Garrison said, “I don’t see whether you have a carved-out dental plan or an integrated dental plan as being the issue that’s going to be dispositive about whether or not dentists and their practices are going to participate in Medicaid.”
Before the vote, State Rep. John Snyder dismissed many of the concerns raised by both groups and urged his colleagues to support the bill and avoid further delays.
“I think a lot of what we’re hearing today reminds me of the old saying, nobody likes the way things are, and everybody hates change,” Snyder said. “I think the easy thing to do, as you mentioned, would be to kick the can a little further down the road.”
Garrison echoed Snyder’s sentiments in his closing remarks, pointing out that a failure to make changes now would lock in a less competitive, antiquated structure through the year 2030. “The work we’re doing now really is planting a tree so that someone else will enjoy the shade.”