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Here is yet another example where profits &political paybacks trump good public policy.

As HMOs gain, the ill lose

Published May 19, 2007

Maybe there wasn’t enough time in the legislative session to help Florida’s property taxpayers,  but there was plenty of time to enrich the state’s managed-care companies to the detriment of the state’s mentally ill.

 The Republican-controlled Legislature bypassed the regular hearing process to quietly tuck lucrative gifts for HMOs into a must-pass conforming budget bill. Companies such as Amerigroup and Tampa-based WellCare Health Plans Inc. that contribute substantial sums of money to Republican state legislators and the Republican Party came out big winners during a session where money was tight and fee increases few.

 In addition to a sizable rate increase,  the Legislature acted to free managed-care companies that cover the mentally ill from the requirement that they spend at least 80 percent of every Medicaid dollar on providing
services. By eliminating this floor,  the HMOs are now free to redirect a larger share of Medicaid reimbursements into their own pockets.

 This will have a negative impact on Florida’s poor,  severely mentally disturbed residents. As these patients start receiving fewer services,  the consequences are easily predictable. They will end up in the criminal
justice system or committed to a state hospital.

 Turning to the managed-care industry to handle the needs of the mentally ill Medicaid population is a relatively new phenomenon. And since their arrival,  community mental health agencies report declines in the quality of care being provided.

 Many service providers have experienced double-digit reductions in annual revenues,  as HMOs limit patient services and throw up bureaucratic hurdles. Service providers have cut staffing levels on the therapeutic side of operations while adding staff to the administrative side to handle the added paperwork. And this is before the HMOs have been released from the requirement that they spend 80 percent on actual services.

 An HMO trade group justifies the elimination of the 80 percent rule by claiming the managed-care industry has shown it can address the needs of the mentally ill. Those who actually care for the state’s mentally ill disagree.

 Now it is up to the state,  and the Agency for Health Care Administration in particular,  to police the HMOs and hold them to their contractual obligations. If an HMO is found to have a pattern of limiting or denying
legitimate care,  the public should be told and the contract should be suspended.

 The Legislature put the interests of big political donors over a vulnerable group of people. Now its up to the executive branch to mitigate the damage.

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