TALLAHASSEE, Fla. — Florida HME providers were working furiously on Wednesday to combat proposed Medicaid legislation they said would place beneficiaries in peril, cost thousands of jobs and force hundreds of HME providers to close.
"It's a massive Medicaid overhaul that was done surreptitiously so people most involved in health care wouldn't be able to respond or be involved in the process," charged Sean Schwinghammer, executive director of the Florida Alliance of Home Care Services. "We don't believe it is best for patients or for business."
Schwinghammer was even more blunt in his email appeal to FAHCS members to contact their legislators: "This is the Titanic running at full speed," he wrote.
On Wednesday, even beneficiaries were calling legislators to object to Florida House Bill 7223, which was introduced April 6. The bill is expected to come up for a vote this afternoon, Schwinghammer said.
Under the proposed legislation, virtually all Medicaid beneficiaries would be moved into health maintenance organizations. They currently have a choice of choosing their own providers or belonging to an HMO.
The bill designates the state's Medicaid authority, the Agency for Health Care Administration, as the "single state agency to administer the program; establishes the Medicaid program as a statewide, integrated managed care program for all covered services; authorizes [the] agency to apply for and implement waivers; provides related and conforming provisions to reorganization of Medicaid managed care."
It's the latest slam against the state's HME providers. Last year, Blue Cross/Blue Shield dropped hundreds of providers from its program and contracted instead with regional companies to provide care and services to its beneficiaries.
Services ranging from HME and physical therapy to home nursing care would be affected under the new proposal.
"There will be no exceptions, not for the elderly, incontinent waiver patients, developmentally disabled patients, children, etc.," Schwinghammer said, noting that House leaders have proclaimed no amendments or exemptions to the bill will be accepted.
Legislators have said the plan would be a money-saver for the state's Medicaid program, which serves about 2.7 million and has seen costs balloon to a staggering $19 billion a year. Legislative analysts have said the state could realize a savings of 2 to 3 percent and even as much as 15 percent under the plan, which would be phased in over five years.
The cost elsewhere in the system could be huge, however, stakeholders said. Some 1,000 HME companies are involved in providing equipment and services to Medicaid patients, according to Schwinghammer, and the bulk of them would lose that business. Under the plan, only three to 10 contracts would be awarded in each of six geographic areas in the state.
The plan is designed to exclude small and medium-sized businesses from participating in Medicaid, Schwinghammer said. "Once the HMOs control it, they can limit it to whomever they want. All the small companies that they don't want in will be out," he said.
As many as 800 companies could close, and 10,000 jobs stand to be lost, he said. "That's a big deal in a state with the second-to-highest unemployment in the country," Schwinghammer said.
"If you want to eliminate jobs, you're going in the right direction," said Joan Cross, executive director of the Florida Association of Medical Equipment Services. Cross said she understands the massive Medicaid bill is crushing to the state, but she objects to the method legislators have chosen to ease that burden.
"They're wanting to do it to save money and they're saying that everyone will have the same care," said a skeptical Cross. "They don't have it clearly thought out. They think they are going to have a team of doctors and hospitals, a disease management team, if you will. They are going to put these groups together and manage the care."
The plan might sound good on paper, she said, but the reality is "nobody wants to take these HMOs because they aren't going to get paid."
Cross, a former HME provider, said she once had to drive to Tampa, an hour away from her Bradenton company, to pick up a check from an HMO. She was one of the lucky ones, she said; others have had to go to court to get their rightful pay.
Both Cross and Schwinghammer questioned the wisdom of changing the system so drastically without first waiting for the results of an experimental project now going on in five counties (Broward, Baker, Clay, Duval and Nassau). The state Senate has already introduced legislation to extend the project to 19 more counties, even though there is a class-action lawsuit against the pilot program and, according to published reports, extensive complaints from physicians and patients alike.
But state lawmakers have said they will not wait for an analysis of the results.
"Everybody was taken by surprise," Schwinghammer said, adding that the bill "didn't go through any committees and it was done over Easter break. They were crafting it on Easter Sunday, so they were really trying to rush this."
If the House does pass the bill, he said, it will move on to the state Senate. If it gets that far, "in all likelihood, it will become law."
FAHCS is urging Florida providers to call all elected leaders in the state about the issue and email all representatives. For more information, see www.fahcs.org.
