Florida Medicaid Program doesn’t make the grade, study says

04/18/07 © Florida Health News
Despite its huge budget, Florida’s Medicaid Program scored poorly in a new national study that ranks state Medicaid programs based on eligibility, scope of services, provider reimbursement and quality of care.

Florida Medicaid ranks 26th, with an overall score of 467.7 out of a possible 1,000 points.

With an annual budget of $15 billion, Florida Medicaid serves 2.1 million people—the fourth largest number in the country.

The report, “Unsettling Scores,” was released Wednesday by the Health Research Group at Public Citizen, a Washington, D.C.-based consumer advocacy organization. For the full report, as well as the Florida analysis, go to: http://www2.citizen.org/hrg/medicaid/

Unlike Medicare, which has uniform coverage across all states, Medicaid programs vary from state to state in terms who is covered and what services they receive.

States with the highest median household incomes tend to offer the best benefits, while states with lower median incomes have lower-ranked programs.

“Millions of people are not eligible for Medicaid because they don’t live in the right state,” said Sidney Wolfe, director of the Health Research Group.

Fueling the disparities in eligibility and scope of services are the numerous waivers granted to the states by the federal Centers for Medicare and Medicaid.

These waivers, which Wolfe said are “not the exception but the rule,” allow states to bypass certain federal requirements, such as the amount and scope of benefits, in restructuring their Medicaid programs.

Florida’s new Medicaid reform initiative, being piloted in Dade and Duval counties, was the result of one of those waivers. However, Annette Ramirez de Arellano, lead author of the study, said that comparative data was collected before Florida’s reform pilots were implemented.

The report noted that Florida’s Medicaid program is 4th in enrollment and 5th in spending, and that “the state is under pressure to control both.” 

Unsettling Scores Chart, Courtesy of Publc Citizen

Here’s how Florida was ranked in the four categories:

Quality of care: Fourth in the nation. Researchers said most of the measures in this category are for nursing home care, and the score reflects Florida’s ”creditable” track record in monitoring long-term care, researchers said.

Eligibility: Ranked 17th. Florida earned points by covering individuals who have very high medical expenses but would otherwise have too much income to qualify. But, it lost points because of the very low income caps it sets for some populations.

Scope of Services: Ranked 35th. Researchers said this reflects the state’s decision not to cover a number of services, such as dental care and rehabilitation services.

Provider reimbursement: Ranked 42nd, even though it pays providers close to the national average.

That’s largely because the study compared states’ Medicaid fees to what Medicare pays providers. The fee differential was largest in Florida for primary care doctors.

Wolfe said “miserly” reimbursement rates are a national trend and make it less likely that all Medicaid participants can access the care they need.

Nationally, the state Medicaid programs are severely challenged: even the best state (Massachusetts) scored only 645.9 points on a scale of 1000.

Half of the top 10 ranked Medicaid programs are in the Northeast: Massachusetts, Vermont, Rhode Island, New York, and New Hampshire.

Of the 10 worst states, three are in the South (Mississippi, South Carolina, and Alabama) and four are in the south central part of the country: Colorado, Texas, Oklahoma, and Missouri.

And, Ramirez said, “No one state program can be considered excellent across all categories. Even top states fall short in some categories.”