If it stays on course, the Florida Legislature could radically change the way care is delivered to the state’s Medicaid enrollees. The Florida House began consideration this week of two measures that would extend a managed care pilot program to all 67 counties, with final action coming as soon as early next week.

Medicaid enrollees living in the state’s five most populous counties are currently covered in a managed care pilot program initiated during Governor Jeb Bush’s administration.  The legislation would extend that program to Miami-Dade County next year, phasing it in over the next five years to the rest of the state.

A similar measure passed by the Senate would extend managed care to 19 additional counties, but would do so in one year.

With final action by the House expected next week, the legislation would go to a conference committee to iron out differences.

Lawmakers say that the move is needed to reduce the cost of Medicaid, both in the near and long term.   While Medicaid enrollment in the state currently stands at 2.6 million, the recently passed federal health care reform could double that. 

The federal reforms expand Medicaid eligibility to 133% of federal poverty level, up from 100%.  And while Washington will initially cover all of the cost of covering new enrollees, that level of enhanced cost sharing ends after 2016. 

Spending on Medicaid is about $19 billion annually, or one-fourth of the state budget.

Critics of the move say that the change would not save enough money to make it worthwhile, and that there was not enough data from the pilot program to justify expanding it to the entire state.

Florida’s Medicaid managed care effort has garnered wide-spread criticism from both providers and enrollees.  It is currently the target of a class-action lawsuit.

Provider organizations, including the Florida Hospital Association and the Florida Medical Association, are opposing the legislation.

Democratic lawmakers failed in their attempts to send the measures back to committee or exempt persons in nursing homes and long term care facilities, but were successful in attaching several minor amendments. 

Unlike fee-for-service, the Florida program pays a set amount for provision of covered services for a specific number of patients.  Payment amounts are also based on providers’ experience and access to primary care physicians.

Proponents of the legislation maintain that, aside from controlling costs of providing care, a managed care system will also reduce incidences of fraud.