Monday, October 20th, 2014

Scott-O-Meter

Reform Medicaid with a federal waiver


"Reforming health care for Medicaid recipients (through a waiver) and state employees to consumer directed care will lower the cost of health care, increase choice of health plans, and save taxpayers $1.8 billion."

Updates

Florida got Medicaid waiver but we will have to wait to assess savings

Rick Scott campaigned on a promise in 2010 that one way for Florida to save money was to expand privatization of Medicaid, which provides health coverage for the poor.

Florida first received a waiver in 2005 under Gov. Jeb Bush for a demonstration project in a few counties. Scott sought to expand the waiver statewide.

Without the waiver, the state paid doctors and hospitals directly via Medicaid. The waiver allows the state to pay private managed care organizations, who then coordinate care.

In early 2013, the state and federal government started to reach an agreement for the waiver -- at the same time that Scott announced that he now supported Medicaid expansion. That was a major change of position for Scott (PolitiFact Florida awarded him a Full Flop), but the Legislature refused to expand Medicaid to about 1 million poor Floridians.

The state negotiated two waivers with the federal government: one for patients in long-term care such as nursing homes and another for poor Floridians who need assistance and live on their own, called the Managed Medical Assistance waiver. Both waivers were approved in 2013; the long-term waiver expires in 2016 and the other in 2017. (The state has the option to renew the waivers.)

As for cost savings, the state negotiated a 5 percent rate cut with private providers, which the state Agency for Health Care Administration predicts will save $650 million a year -- which translates to close to $1.9 billion over three years. The bulk of the savings is expected to come from the Managed Medical Assistance waiver.

The long-term care program completed its rollout March 1, 2014, and the Managed Medical Assistance program completed its rollout Aug. 1, 2014, so there isn't enough data yet to evaluate if Florida is on track to save $1.8 billion.

Florida Chain, a group that advocates for affordable health care, said it's not a stretch to believe that the waiver could accomplish the savings.

"However, I think a fair question is whether even more could have been saved over a longer period by setting up a program of managed care that did not rely on for-profit companies to exact savings in order to meet the demands of investors and shareholders," said spokeswoman Leah Barber-Heinz.

She also said it's possible that some savings could be the result of efforts to delay or deny access to care "so front-end savings alone may not provide the full picture."

Scott achieved a big step toward his promise by getting the statewide waiver, but it's too soon for us to evaluate whether he has achieved the savings and the full impact of the program.

We continue to rate this In The Works.

Sources:

PolitiFact, "Rick Scott opposed Medicaid expansion before he supported it," Feb. 25, 2014

Interview, Shelisha Coleman, Florida Agency for Health Care Administration, Aug. 28, 2014

Interview, Leah Barber-Heinz, spokeswoman Florida Chain, Aug. 28, 2014

Feds and Florida working on Medicaid waiver agreement

After trying for two years, Gov. Rick Scott achieved a victory in February 2013: The U.S. Department of Health and Human Services (HHS) granted Florida its request for a waiver for Medicaid. The medical assistance waiver applies to the Statewide Medicaid Managed Care Program that serves more than 3 million Floridians. Weeks earlier, HHS had granted a separate smaller waiver request for people who are disabled and seniors.

Scott celebrated that he was "two-for-two in our request for Medicaid flexibilities. This helps Florida taxpayers by lowering costs and Florida families by improving healthcare services.” The much larger Medicaid story occurred the same day: Scott announced he would accept a massive federal Medicaid expansion -- after he had fought ObamaCare for years.

 

The Feb. 20 letter from HHS director Cindy Mann stated that the two parties had "reached agreement in principle” and would work toward a final agreement.

 

A spokeswoman for the Florida Agency of Health Care Administration said on March 26 that the state remained in communication with CMS, and that officials are discussing conditions to finalize program details.

 

Scott campaigned in 2010 that one way to shrink the state budget was to expand privatization of Medicaid, which provides health care to the poor. He said that if the federal government signed off on it, he could cut $1.8 billion.

We asked a spokesman when Scott expects to achieve those savings and did not get an immediate reply. Scott's 2013-14 budget estimates Medicaid expenditures at $22.5 billion.

Scott's promise has been in limbo for more than two years. This month he made considerable  progress when HHS said it had reached an agreement in principle to give Florida a waiver for Medicaid. We will monitor whether the federal government finalizes the arrangement and if the savings occur. The promise remains In the Works.

Sources:

Gov. Rick Scott press release, "Florida wins second Medicaid waiver granting flexibilities,” Feb. 20, 2013


Gov. Rick Scott, Remarks about Medicaid expansion, Feb. 20, 2013


U.S. Department of Health and Human Services, Letter to the Florida Agency for Health Care Administration, Feb. 20, 2013


U.S. Department of Health and Human Services, Letter to the Florida Agency for Health Care Administration, Feb. 1, 2013


Miami Herald Naked Politics blog, "Florida receives go-ahead to privatize Medicaid. Is expansion next?” Feb. 20, 2013


Gov. Rick Scott, 2013-14 Budget


PolitiFact, "Gov. Rick Scott ignores flaws in state study, says Medicaid expansion will cost Florida $26 billion,” Jan. 8, 2013


Interview, Michelle Dahnke, spokeswoman for the Florida Agency for Health Care Administration, March 26, 2013

Scott wants to meet with Sebelius about Medicaid waiver

Gov. Rick Scott wants major changes to Medicaid, a long-standing health care program for the poor. He wants to see more Floridians in private managed-care plans in an effort to save money.

To do that, Scott needs a waiver from the federal government to make changes to the program, which is a joint state-federal partnership.

But his efforts remain in limbo as the federal Centers for Medicare and Medicaid hasn't ruled on whether to grant that waiver request.

We were unable to get an answer from the Centers for Medicare and Medicaid about why it is taking so long to reply to Florida's waiver request and the timeline for a decision.

Bruce Rueben, president of the Florida Hospital Association, said in an email to PolitiFact Florida that the waiver would apply to the period starting July 2014, so the federal government has until the end of June 2014 to approve it. Currently, CMS and the the state's Agency for Health Care Administration are discussing the waiver application, Rueben said.

"In Florida, Medicaid is a huge program with 3.3 million people currently enrolled at a cost of over $22 billion,” Rueben wrote. "It is not surprising that the feds are taking a very careful and thoughtful approach.”

On Nov. 16, Scott wrote a letter to U.S.  Health and Human Services Secretary Kathleen Sebelius asking for a meeting to discuss both the waiver request and the federal health care law.

"We appreciate all the work your staff has done on the current Medicaid waiver request and look forward to your approval,” he wrote.

Sebelius didn't specifically respond to Scott's request. But on Nov. 20. she sent each state's governor a  letter about implementing the Affordable Care Act that stated "I also welcome the opportunity to meet with you during the upcoming weeks to discuss implementation.”

Scott was a vocal opponent of Obamacare, but he's toned down his rhetoric since President Barack Obama won re-election.

Scott's letter indicated he might now be willing to work with the federal government on some aspects of the health law, but he also said he needed more information.

Federal officials may be holding back a decision on the waiver until they see what steps Scott would be willing to take to implement the federal law.

Scott can't deliver on his promise for a waiver until the federal government acts. With Obama's re-election, the health law is unlikely to be repealed. Scott's letter shows a new round of negotiations between the state and federal government are likely to begin. The outcome, of course, is unknown.  

This promise remains In the Works.

Sources:

Miami Herald, "Florida facing quick deadline to increase Medicaid providers" pay,”Nov. 16, 2012

U.S. Centers for Medicare and Medicaid Services, Florida Medicaid waivers, Accessed Nov. 27, 2012

PolitiFact,  "Scott retools his rhetoric on health care law,”  Nov. 20, 2012

Gov. Rick Scott, proposed budget, Dec. 7, 2011

Letterfrom Gov. Rick Scott to U.S. Health and Human Services Secretary Kathleen Sebelius, Nov. 16, 2012

Letterfrom U.S. Health and Human Services Secretary Kathleen Sebelius to governors, Nov. 20,  2012

Tampa Bay Times, "Striking a cooperative tone, Scott asks to meet with health care officials,”Nov. 16, 2012

Interview, Michelle Saghafi, spokeswoman for U.S. Centers for Medicare and Medicaid Services, Nov. 16, 2012

Interview, Jackie Schutz, spokeswoman for Gov. Rick Scott,  Nov. 21, 2012

Interview, Bruce Rueben, president of the Florida Hospital  Association, Nov.  26, 2012

Scott unveils budget with Medicaid cuts but awaits word from the feds on waiver

Florida Gov. Rick Scott wants to take a massive bite out of the state's budget by saving money on Medicaid, a health care program for the poor.

"Reforming health care for Medicaid recipients (through a waiver) and state employees to consumer-directed care will lower the cost of health care, increase choice of health plans, and save taxpayers $1.8 billion," Scott said during the 2010 campaign.

Scott and state lawmakers have sought a waiver from the federal government to put more Floridians in private managed-care plans in an effort to save money.

Florida first received a waiver in 2005 for a demonstration project in a few counties including Broward. In 2010 before Scott was elected, the Legislature agreed to seek a three-year extension of the waiver. Scott traveled to Washington on Jan. 31, 2011, to make the case for the expanded waiver.

But that request (as of Dec. 9, 2011) remains pending, said Alper Ozinal, a spokesman with the Centers for Medicare and Medicaid Services. Ozinal said there was no timeline for a decision.

The state is operating under a temporary extension through December 15, according to Shelisha Coleman, a spokeswoman for the Florida Agency for Health Care Administration.

On Dec. 7, Scott unveiled a proposed budget for 2012-13 that would impose new caps on how much the state pays to treat Medicaid patients. Scott suggested using average cost data to set a flat rate for each of 10 types of hospitals.

"No program in this state has grown this fast or costs this much," said Scott, pointing to a chart showing next year"s projected Medicaid costs at $21.6 billion. "If we do nothing, this line will bankrupt our state. We"re going to step up and do something to stop these increases."

Scott proposed setting Medicaid costs at about $19.5 billion -- or about $2.1 billion less than the projection.

Scott can't fully deliver on his promise to reform Medicaid until the federal government responds to his waiver request. And the fate of Scott's budget proposal now lies with the state Legislature.

So for now this promise is still In the Works.

Sources:

Centers for Medicare and Medicaid Services, Medicaid waivers, accessed Dec. 9, 2011

Florida Agency for Health Care Administration, Florida Medicaid Reform Pilot, accessed Dec. 9. 2011

Gov. Rick Scott, proposed budget, Dec. 7, 2011

Miami Herald/St. Petersburg Times, "Scott calls for more education spending, less on Medicaid," Dec. 7, 2011

Interview, Alper Ozinal, spokesman for the U.S. Centers for Medicare and Medicaid, Dec. 9, 2011

Interview, Shelisha Coleman, spokeswoman for the Agency for Health Care Administration, Dec. 9, 2011

Scott goes to Washington looking for Medicaid waiver

Florida lawmakers, including Gov. Rick Scott, believe one of the ways to shrink the state budget is to expand privatization of the state-administered Medicaid system. But before they can do it, the federal government needs to sign off on the idea.

During the campaign, Scott pledged that if he could get the federal government's okay, he could slash $1.8 billion from the state budget. To put that in perspective, that is about half of the projected budget shortfall for 2011-2012.

"Reforming health care for Medicaid recipients (through a waiver) and state employees to consumer-directed care will lower the cost of health care, increase choice of health plans, and save taxpayers $1.8 billion," Scott said.

Florida's Medicaid program -- which provides health care to low-income individuals and families -- costs $20.2 billion for fiscal year 2010-11 with the state and federal government sharing about equally in the cost. But the cost is going up -- bad news as state revenues are shrinking. The Medicaid program is expected to climb to $25.08 billion by 2013-14. For some perspective, the entire state budget in 2010-11 was about $70.4 billion.

Scott and lawmakers believe they can save money by receiving a waiver from the federal government to put more people in private managed-care programs. Critics, meanwhile, worry for-profit providers will cut corners when it comes to patient care and deny medical services to increase profits.

On Jan. 31, 2011, Scott was in Washington, D.C., to meet with Health and Human Services Secretary Kathleen Sebelius to ask for expedited approval of a Medicaid waiver, the St. Petersburg Times reported. "Both had an open mind and listened to each others' concerns," Scott spokesman Brian Burgess said.

But the Associated Press reported that the federal Centers for Medicare and Medicaid Services likely won't make its decision on a waiver until June, after the Legislature's March 2 to May 6 session ends.

"This has been a controversial waiver with so many issues expressed by advocates about access and quality of services," spokeswoman Mary Kahn said. "We'd have to take a very, very close look to make sure those concerns can be addressed and make sure that Medicaid beneficiaries can best be served by extending the waiver."

Scott clearly has made his move. Now he waits for the federal government's response. For now, that means this promise is In the Works.

Sources:

St. Petersburg Times, "Gov. Rick Scott presses HHS Secretary Kathleen Sebelius for Medicaid waiver," Jan. 31, 2011

Associated Press, "Fla. lawmakers could expand Medicaid privatization," Feb. 1, 2011

PolitiFact Florida, "Pam Bondi says Medicaid will eat up half of state budget in 2015," Sept. 8, 2010

Centers for Medicare and Medicaid Services, Medicaid Program - General Information, accessed Feb. 2, 2011