Two factors caused Florida to act decisively in 2006
to reform its Medicaid program beginning with a pilot
project in Broward County and the Jacksonville area.
The purpose of the pilot project was to provide policy
makers with an opportunity to obtain a fair evaluation
the reforms being tested. The experiment was cleared
to proceed after Florida officials obtained a waiver from
the Federal government, which also has an interest in
exploring ways to contain costs and improve the quality
of care.
Of the two factors that prompted the state to act,
cost was inarguably a major concern. The trend in
state spending on Medicaid was simply unsustainable.
Had it continued unabated, the program could have
consumed roughly 60 percent of the projected state
budget by 2015. This would have forced either (a) a
large tax increase, (b) severe cutbacks in education,
corrections, and other important programs the state
funds from its finite supply of general revenue, (c)
major reductions in the compensation paid to Medicaid’s
providers at a time when their costs were rising,
further discouraging those providers from accepting
Medicaid patients, or (d) some combination of all of
the above.
Although money was a major factor in motivating
the state to act, it was not the only factor. The other
concern was the inconsistent quality of care provided
to Medicaid’s clients. Some patients have reported
their extreme dissatisfaction with the care they or
their children received through Medicaid. A chronic
complaint is that the Medicaid clients who were
dissatisfied have had little recourse.
One feature of the pilot project was to give
Medicaid’s clients as many choices as feasible, along
with counseling to assist them in making a selection
that best suits their needs. Another feature was an
emphasis on the types of care that help patients
maintain their “wellness” rather than merely treating
them when they become ill. This method of
reining in costs has multiple benefits beyond merely
controlling costs.
After evaluating the evidence obtained thus far,
we conclude that Florida’s pilot project not only
ought to be continued in the places where it is
already underway, but also that the reforms instituted
under this pilot project ought to be extended to the
remainder of the state.
