In Florida, a health-care quandary

Almost overnight, Florida has gone from being an ardent opponent of the federal health-care law to a laboratory for an ambitious experiment under it.

If state lawmakers back Gov. Rick Scott’s plan to expand Medicaid, it will be an experiment with a determinedly free-market twist. Scott’s turnabout on Medicaid last Wednesdaycame a few hours after the federal government tentatively approved his application to fully privatize the federal-state program for the poor.

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If the Republican-controlled legislature approves his plan when it meets next month, Florida would also become one of the largest states to require virtually all recipients of Medicaid to enroll in private managed-care plans, which can limit which health providers patients can see.

That development has put health providers and consumers in a quandary: Most are elated that more than 1 million Floridians are in line to gain health coverage starting in 2014 and that hundreds of millions in federal dollars will flow into the state to cover their medical services. But they’re also concerned that the coverage will be delivered through managed-care plans with a mixed record of providing quality care in Florida.

Consumer groups worry about whether the health plans will have enough providers, especially in rural areas, and whether they’ll approve services in a timely way.

Nursing-home operators fear that for-profit insurers may try to move residents into lower-cost settings, even when that may be unsafe.

And doctors and hospitals say they’re concerned about getting paid on time and about having trouble getting services approved for their patients.

“Hospitals’ experience with managed care varies plan to plan in the ability to get patients into the right level of care . . . and plans paying claims efficiently and in a timely manner,” said Bruce Rueben, president of the Florida Hospital Association.

Scott is not the first Republican governor to support the Medicaid expansion, which the Supreme Court made optional for states when it upheld the health-care law last June. The governors of Ohio, Arizona, Michigan, Nevada, North Dakota and New Mexico preceded him in announcing plans to expand their programs. But Scott’s decision is arguably more significant due to his state’s size (19 million people), its large number of uninsured (4 million) — and his outspoken opposition.

Other states that have put nearly all their Medicaid recipients in managed care include Arizona, Tennessee, Kentucky and Pennsylvania, according to Joe Moser, interim executive director of Medicaid Health Plans of America, a trade group. “It’s a proven model and not a new concept,” he said.

About two-thirds of states already use managed-care companies as a part of their Medicaid programs. Florida has done so for nearly two decades, with more than a third of its 3 million Medicaid recipients in the private health plans. These HMO-style plans get paid a set amount of money by the state to provide coverage, and the enrollees generally get care only from doctors, hospitals and other providers who have contracts with the plans.