Publisher’s Note: Will the Medicaid overhaul favor certain FL-based HMOs?

 It seems only yesterday it was August 2, when hundreds of pages describing the Florida Medicaid overhaul were released.  The goal of this overhaul is to shift Medicaid beneficiaries into “managed-care plans” by 2013 while using a heavily debated pilot program until then to set the wheels in motion.

But which companies stand to benefit most from this overhaul, and why?  It seems that a little-noticed clause amidst the state’s overhaul proposal for Medicaid would stand to give preference to health insurance companies based in Florida.

Companies would essentially compete to win contracts for enrolling the 1.5 million Medicaid recipients, according to the proposed laws by the Agency for Health Care Administration.  This “competition for contracts” would be based on a tiered system, allocating points for different assets, such as being based in Florida.  The companies that have all their operations in Florida (call centers, claims payments, etc.) would receive the most points based on the tiers. 

This could potentially bring more business and jobs to Florida, and with an economy that has a current unemployment rate of 10.7 percent, that would be a good thing.  One of the ever-present dangers though of a complex system is to lose sight of the end consumer: higher rates, deductibles, and cost to those who need the plan. So while it could be good for Florida’s economy it’s vital that the people who depend on these programs are not penalized.

Of course, none of this can be carried out unless the Centers for Medicare and Medicaid Services approve the overhaul, which the state submitted on August 1.

 If the overhaul is passed, then the state will begin the process by inviting HMOs and provider service networks to apply and enroll the elderly and disabled Medicaid population beginning 2013 into managed-care plans.  The subsequent phases would include enrolling beneficiaries like healthy children and pregnant women (who mostly are already enrolled in HMOs).  The only group that would be exempt from this process is the developmentally disabled.  


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