Rick Scott, a former health care company CEO, campaigned on promises in 2010 to fight to repeal Obamacare and reform Medicaid with a waiver.
Florida first received a waiver for the program in 2005 under Gov. Jeb Bush for a 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 2013, the state and federal government reached agreements for two waivers: 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.
The waivers will continue after Scott leaves office; the Managed Medical Assistance Waiver has been extended until 2022 and the Long-Term Care Waiver has been extended until 2021.
The Scott administration says the moves have saved the state billions. The state's Medicaid program has cost the state $7 billion less than if costs had grown at the medical care inflation rate; and $4 billion less than if costs had grown at the general inflation rate, according to Mallory McManus, a spokeswoman for the state Agency for Health Care Administration.
Under the long-term care component of the program, the health plans have assisted elders and people with disabilities living in nursing facilities who wished to return to their home or another community-based setting.
McManus said that the Medicaid quality scores in 2017 were the highest in the Florida Medicaid program's history. Thirty reported measures showed improvement over 2016 scores, including adolescent well care visits, adult access to preventative care, breast cancer screening and post partum care.
Anne Swerlick, an expert on health issues at the Florida Policy Institute, said these measures do not drill down on how well these private plans are serving people with the highest needs, such as medically complex children or adults with severe disabilities.
"Having to deal with multiple private plan protocols, such as their doctors having to jump through bureaucratic hoops to prove that the services they are prescribing are 'medically necessary,' or getting prior authorization for services and medications, can be administratively burdensome," she said. "Meanwhile consumers encounter disruptions in care and ongoing anxiety that they will not be able to get what they need month to month."
Advocates for Medicaid expansion criticized Scott and the state Legislature for not expanding Medicaid as part of the Affordable Care Act. Scott was initially against expansion but then flipped in favor of it. He was never, however, a strong advocate, and the Legislature never acted to expand the program to cover more Floridians.
Scott promised to reform Medicaid with a waiver. The state established waivers with the federal government in 2013 and they will continue beyond his tenure as governor. We rate this Promise Kept.