With Medicaid rebid on the horizon, the time to act is now

MEDICAID - Glowing Neon Sign on stonework wall
Will the Senate stomach the House's thoughtful additions to a bill they already passed?

First, kudos to Sen. Jason Broduer and Rep. Sam Garrison.

Crafting a good Medicaid bill isn’t easy, and the lawmakers who manage to do it won’t see the accomplishment heralded in positive TV ads, direct-mail pieces or endorsements.

But Medicaid legislation is important. There’s a lot at stake for the 5 million Floridians who depend on the federally funded program, and the current system has failed thousands of them.

Just look at Sunshine Health. As a result of a technology meltdown, tens of thousands of health care claims for the sickest Floridians went unpaid for three months.

Sunshine Health is Florida’s largest Medicaid payment vendor, made even bigger last year when it absorbed Wellcare, the state’s second-largest Medicaid payment vendor. Together, they have contracts worth $31.6 billion with the state’s Agency for Health Care Administration — with money like that flying around, there’s no excuse for a glitch in the system.

But those contracts are coming to an end because plans that offer Medicaid have to rebid for a state contract every six years, and the competitive bidding process for the next term will be published sometime in the next year.

This is the state’s opportunity to fix the system and fix it right. Simply put, if it isn’t fixed now, it won’t be until 2028.

In its current, House-amended form, the Legislature’s major Medicaid package (SB 1950) places a cap on automatic enrollment, which assigns families at random if they have not selected their plan.

Under the current system, big plans get bigger. But under the bill, plans with 50% or more of the market share in any region would not be able to accept automatic enrollment clients, lest they become too big to fail.

The bill also strengthens guardrails around negotiations between hospitals and Medicaid plans so people can get essential health care services when they need them. There are some critical services that only a hospital can provide, and if a member’s plan is not covered by that hospital, they may not get care at all.

“We’re doing everything in our power to make sure you have the access to the care you need,” Garrison said during floor debate (1:05:11) on Tuesday.

Garrison on Monday amended the bill to allow plans to reinvest revenue surpluses in workforce development and career training, rather than returning the money to the state coffers. It’s a concept proponents say will tackle some of the major challenges facing the health care system, which has been wracked with worker shortages.

The amendment was the product of the committee process for Garrison’s own Medicaid bill (HB 7047), which was honed through hours of debate.

He said the goal is to ensure Florida does right by Medicaid recipients — who often don’t have a voice in the legislative process — so every one of them has access to the full scope of providers available in the state.

The House adopted Garrison’s strike-all on Monday and subsequently passed the bill Tuesday, kicking it back to the Senate.

Now the question is whether the Senate will stomach thoughtful additions to a bill it already passed.

Tonight, Sen. Aaron Bean filed an amendment to the bill making clear the Senate is unwilling to meet in the middle. The Legislature still has a chance to get this right, but time is running out. With 5 million Floridians depending on Medicaid, there’s a lot at stake.

Peter Schorsch

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including Florida Politics and Sunburn, the morning read of what’s hot in Florida politics. Schorsch is also the publisher of INFLUENCE Magazine. For several years, Peter's blog was ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.


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