FLORIDA: Unique Medicaid Pilot In Works
A coalition of health care providers in Broward and Miami-Dade counties is close to embarking on a pilot program under which they will assume the financial risk of providing care for Medicaid recipients. According to the South Florida Business Journal, "the last big wrinkle" is whether or not the state will refer Medicaid recipients to the network. The providers claim they need referrals from the state Agency for Health Care Administration to secure the 25,000 Medicaid enrollees they'll need in the first year to stay afloat. But without an agreement from the state, the providers predict that only 15,000 beneficiaries will enroll. Miami's Jackson Memorial Hospital is representing the network members -- 14 hospitals, 500 primary care physicians and 2,000 medical specialists -- at the bargaining table. "The infrastructure ... is significant," said Jackson CFO Ronald Ruppel, adding, "There's a lot of benefits and efficiencies that we need to make it financially viable."
The state strategy for Medicaid recipients who "do not express a choice of medical providers" is to steer "them to either Medicaid-qualified physicians under the Medi-pass program, or to Medicaid HMOs." Ruppel suggested that "the agency include the network among these recipients of so-called mandatory referrals" in an effort to boost enrollment in the provider network, but the state is hesitant to make such a commitment. Agency spokesperson Nina Bottcher said, "We can't guarantee any number because it is a choice." However, Bottcher projected that the network could potentially secure 30,000 enrollees within two years, "providing it signs up enough doctors who will bring in Medicaid patients of their own." She said the agency "may find flexibility within its mandatory-referral formula come June, when the law giving HMOs access to all undecided patients is set to expire" (Cox, 11/2 issue).