Managed Care


Florida's Medicaid Waiver Will Be Scrutinized Closely

MANAGED CARE November 2005. © MediMedia USA
Editor's Memo

Florida's Medicaid Waiver Will Be Scrutinized Closely

John A. Marcille
MANAGED CARE November 2005. ©MediMedia USA

John A. Marcille

Sometimes, following the changes in health care is like trying to take in several tennis matches at once. You might wind up knowing who won, but you'd be hard-pressed to say how it happened.

Employers want to shift more of the financial burden to employees — hence the growing interest in consumer-directed health care. But what's this? Seems that there's some shifting going on in the public sector as well.

Medicaid may meet managed care in a big way in Florida, thanks to the recent federal approval of a plan that Gov. Jeb Bush hopes will cut skyrocketing spending on the entitlement program.

On Oct. 19, as we were beginning to put the finishing touches on this issue, Health and Human Services Secretary Michael Leavitt approved a Medicaid waiver application that will shift 210,000 beneficiaries in Broward and Duval counties into managed care beginning in July 2006. That's pending approval by the state Legislature, which plans to hold a special session on the matter next month.

Entrusting these beneficiaries to managed care plans can potentially be good for them, while controlling costs. But it will be some time before we know whether they got the details right, particularly a provision that relates limits on a person's care to his historical usage. If it is intended to curb abuse, fine, but after all, health insurance guards against catastrophic costs. Medicaid may not be "insurance" per se, but it has much the same function and purpose.

What's going on in Florida isn't just an exercise in state budget management. It's also an opportunity for insurers to demonstrate their usefulness — again.


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