Skip to main content

An article in the Bradenton Herald last week posed the question, “Can Florida’s Medicaid reform plan be the model for the nation?” And it’s a very good question. Florida is barely into its managed-care roll out, and many questions have yet to be answered.

“Does the new system cost less because insurers are providing more efficient care or are they simply giving patients less care?” It turns out that the in the state’s pilot, the most successful groups in the HMO networks are being paid on a fee-for-service system, the same system that the state is trying to move away from. Hospitals love the amount of payment they receive in the new system, but physicians find that their reimbursement rates are low. Seriously ill patients are being bounced from provider to provider as HMO’s enter and then leave the program and patients are forced to repeatedly navigate a complicated system to get coverage for their medications and doctors.

Taking the question outside of Florida and looking at its application for the nation as a whole, and it’s more of the same. Other states are trying to implement the same type of managed-care model for their Medicaid programs. We discussed some of the lessons lessons to be learned for Medicaid managed care in a blog post a few weeks ago.

Anyone who thinks this is a good idea should think twice. Texas legislators are learning that both patients and providers alike are struggling in the face of their Medicaid reform. The state of Massachusetts just discovered that its managed care transition wasn’t the bargain it hoped for. Add to this, the data from a Bloomberg study, which showed that in five of the biggest states using managed care, the longer-term costs could eat up any potential savings that could be realized through a managed care program, and you get a system that definitely not a model to be replicated across the nation.

To find out more about how managed care is impacting community pharmacies nationwide, visit Pharmacy Choice and Access Now today.

Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags


More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  Dear God...Rick Scott for everyone ..that is (1+ / 0-)
    Recommended by:

    the ticket.  I live here in Florida.  They charge co pays..
    on Schip.  it stinks.. They pick your doctors.. it stinks.
    It is all greed. all republican all the time with corruption amuck !  Yes....Rmoney would bring Florida to the rest of you.

    We the People have to make a difference and the Change.....Just do it ! Be part of helping us build a veteran community online. United Veterans of America

    by Vetwife on Fri Oct 12, 2012 at 08:00:44 AM PDT

  •  My other half's Florida Medicaid HMO (0+ / 0-)

    has switched doctors on him 3 times in the past year. How do you manage chronic conditions that way? Now he's in the same clinic system the kids and I are in through our different medicaid HMO's. Problem with that is it takes 2 weeks to get an appointment unless you've been in the ER. They expedite follow up appointments. So you end up using the ER for urgent care instead of just emergent care, just so you can get in to see the PCP in a timely manner.

    I just went through this with the pinched nerve in my neck that has my shoulder locked up. I couldn't get an appointment with my pcp for 2 weeks, so ended up going to the ER. I had an appointment then with the clinic in less than a week after that.
    Now I have an appointment for blood work, an ortho referral, an MRI referral and a referral for a Neurologist (I had one of my 'seizures' while in the doctor's office).

    I shouldn't have had to go through the ER however to get timely care.

    "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

    by FloridaSNMOM on Fri Oct 12, 2012 at 09:17:25 AM PDT

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site