AHCA seeks expansion of 'Medicaid Reform' to 20 counties

(Note: The title of Greg Mellowe has been corrected; it was misstated in an earlier version.)

By Carol Gentry
10/202008 © Florida Health News 

Even as It proposes cuts to a number of programs, the Agency for Health Care Administration has recommended expanding the Medicaid pilot project usually called "Reform" to 20 more counties, including Miami-Dade. The pilot, which now operates in five counties under a federal waiver of the usual Medicaid rules, requires beneficiaries to enroll in managed care, usually HMOs, that can offer extra benefits but also can cap them.

Benson

The request was sent to the governor's office last week, just after release of a report by a team at the Georgetown University Health Policy Institute, who said there is too little information yet to know whether the pilot project saves any money for taxpayers or improves care to patients. But the report noted that doctors in the two largest counties where the Reform project is operating are complaining about paperwork hassles and that some of their patients have trouble getting access to specialty care. 

Patients have registered confusion in how the program works, the researchers said, adding that the project "appears to be moving in the wrong direction." (See Florida Health News' coverage of the report and of AHCA's proposed cuts.)

AHCA didn't say why it was offering the expansion proposal -- which would require hiring two more analysts -- at the same time it was submitting suggestions of program and job cuts of up to 10 percent, as all agencies have been asked to do by Gov. Charlie Crist's office in case the current economic crisis forces further slashes in spending. Spokesman Fernando Senra said Monday morning that he would have to check on that.

It's "almost surreal," said Greg Mellowe, policy director for Florida CHAIN, a consumer group that has consistently opposed the Medicaid Reform project. "It reveals the extent to which AHCA continues to be in denial about the problems dogging the Reform Pilot," he wrote in an e-mail. "The Agency is essentially telling the Governor that expansion is simply an automatic next step and that they're ready to proceed."

The request includes an increase in Medicaid payments for specialists to increase access. It now goes to Gov. Charlie Crist, who decided not to recommend expansion of the pilot project to the 2008 Legislature on the advice of then-AHCA Secretary Andrew Agwunobi, who in turn had listened to the advice of his Inspector General, Linda Keen. However, Agwunobi left early in 2008 and was replaced by Holly Benson, who helped push Medicaid Reform through the Legislature as a state representative while Jeb Bush was governor. Keen, who wrote a report noting flaws in the pilot project a year ago, resigned under pressure a few months after Benson took over at AHCA.