Florida’s Medicaid Enrollment Is Growing — Even Without Expanding EligibilityBY JASON D. FODEMAN, M. DCritics who denounce Florida legislators for once again refusing to expand eligibility for Medicaid ignore the fact that this badly flawed program is rapidly expanding anyway, even without that proposed change.Indeed, new data surfacing during the sign-up period for the Affordable Care Act (ACA) showed that Florida’s Medicaid enrollment rose by a whopping 8 percent in the six months following the ACA’s disastrous start last October 1, with more new enrollees yet to come.These new Medicaid enrollees are the so-called “out-of-the-woodwork” patients whose emergence was widely forecast in the wake of the ACA’s individual mandate to “buy health insurance — or else!”Worse, for a state where Medicaid is already taking huge chunks of revenue away from other priorities ranging from education to the environment, the feds will pay only about 56 percent of the costs, not the higher amounts they proffered as bait to entice states to alter their income threshold in order to add even more enrollees.This spike in Medicaid enrollment not only means added expense for the state and more hassles for patients trying to find a doctor who accepts Medicaid, but it will also pile more work on Florida’s Agency for Health Care Administration (AHCA) – and at an especially bad time.That’s because this often-troubled agency is in the process of overseeing a statewide rollout of a managed-care approach first proposed in studies The James Madison Institute (JMI) published several years ago.That approach, which independent analyses have shown improves patients’ care while also saving the taxpayers’ money, got a trial run in a pilot project in five Florida counties, including Broward and Duval. Now it’s going to be used statewide.Therefore, instead of undertaking yet another huge expansion of Medicaid, the state should instead take full advantage of this timely opportunity to improve medical care for the medically needy.Further expansion of eligibility for Medicaid is not the way to do it. Despite Florida’s reforms, the program’s fundamental flaws remain deeply ingrained in the core of the federal Medicaid statute, which has created a program plagued by bureaucracy, skyrocketing costs, restricted access, and compromised care.These problems can’t be fixed without comprehensive Medicaid reforms that include features such as health saving accounts, which foster personal responsibility. Alas, reforms must begin at the federal level, where the current political alignment makes change unlikely. Until the feds allow the states more leeway to experiment, placing even more Floridians in this flawed program is not a good solution.In the meantime, the federal Medicaid statute leaves states with few options to control costs other than paying providers less and less. The low reimbursements have jeopardized patients’ access to timely, high quality medical care. Many providers refuse to accept Medicaid patients.Expanding eligibility for Medicaid would only inflict these problems on more patients. And placing an additional strain on this already strained system could worsen the care provided for those already enrolled in the program as well as those who were rendered newly eligible.To improve care for the underserved, Florida’s Medicaid program is not in need of more enrollees but more reforms. The two provisions of the federal Medicaid statute that especially need reform are the “comparability” and “statewideness” clauses.In general, these provisions force Florida to offer the same benefit to everyone, everywhere in the state. This shotgun approach to medical care fails the needy because different patients have different medical needs.The federal government’s “maintenance of effort” requirement, which prevents states from tightening eligibility and enrollment criteria, also greatly complicates states’ efforts to improve Medicaid patients’ care. This provision should be repealed as well.These federal statutory provisions may have been enacted with the best of intentions, but in practice they hamstring innovation and impede the efficient use of resources to provide the best care.Florida should use the attention generated by the Medicaid expansion debate as an opportunity to work with federal regulators and local health systems to reform the program to better meet the needs of the beneficiaries. Florida’s underserved deserve nothing less. Jason D. Fodeman, M.D., is a board-certified internal medicine physician and an adjunct scholar of The James Madison Institute.
