Florida: Three years in, Medicaid experiment tough to measure

Jun 2 2009

"Nearly three years into a Medicaid privatization program former [Florida] Gov. Jeb Bush said could be a national model, state officials say they do not have crucial data to measure the program's effectiveness, including how many patients' treatments and prescriptions have been approved or denied," the AP/Miami Herald reports.

Under the pilot program, which began in October 2006, "the government pays private companies a set amount for handling a specific number of residents in the counties - similar to an HMO in the private sector. The companies, in turn, decide how to care for people, including which doctors they can see and what medicines and treatments can be prescribed." But "patients and health care advocates have complained that they can't get doctors appointments and medications under the program," and a study by the Associated Press found that "25 percent of doctors in Broward and Duval counties, the two biggest counties in the pilot program, have dropped out because of red tape and an inability to treat patients as they see fit."

There is "little evidence" that the program "has improved health care or saved the state money." Florida's Agency for Health Care Administration, which "oversees the pilot" told the AP in an email that due to an overhaul of their computer system, they "do not have usable data at this time." The University of Florida was paid to conduct an independent study of the program but never received the data; other research groups have been denied access to data as well, according to the AP. Patient complaints and studies have put the program "under fire." Patients say they "have to pick between plans that cover either their doctors or medicines- not both."

About "202,000 of Florida's 2.1 million Medicaid beneficiaries were in enrolled in a reform plan." But many of those patients have not had access to care since "WellCare, the largest HMO in the pilot, stopped caring for about 80,000 reform patients in May, saying state budget cuts made it economically unfeasible to offer quality health care" (Kennedy, 6/1).