ENROLLED
2010 Legislature SM 4-A
20104Aer
1
2 A memorial to the Congress of the United States,
3 urging Congress to amend Title XIX of the Social
4 Security Act and declaring the intent of the Florida
5 Legislature to amend Florida Statutes relating to the
6 Florida Medicaid program.
7
8 WHEREAS, the Constitution of the United States establishes
9 a limited Federal Government and guarantees the rights of
10 individuals and the rights of states, and
11 WHEREAS, the Florida Constitution requires a balanced
12 budget and establishes the foundation for the state’s fiscal
13 responsibilities, and
14 WHEREAS, the Medicaid program was established in 1965 as a
15 federal and state partnership, based on shared responsibility,
16 distinct authority, and mutual financial participation, and
17 WHEREAS, Florida’s Medicaid program has operated for 45
18 years with authority to determine eligibility, define covered
19 services, and set payment levels, and
20 WHEREAS, decisions by the Florida Legislature about
21 Medicaid must be made after consideration of the ongoing tax
22 burden carried by Floridians, the state’s available resources,
23 and other state obligations, and
24 WHEREAS, the federal Patient Protection and Affordable Care
25 Act eliminates state discretionary powers over eligibility by
26 mandating coverage of at least 1.8 million new enrollees in
27 Florida and prohibiting any changes to current eligibility
28 standards, and
29 WHEREAS, the Patient Protection and Affordable Care Act
30 further hinders the state’s ability to manage its resources by
31 mandating previously optional services, requiring specific
32 payment levels to certain providers, and imposing numerous
33 additional administrative requirements, and
34 WHEREAS, the cumulative effect of new federal requirements
35 is to commandeer an increasing amount of Florida’s resources
36 while leaving the state with few options for cost containment or
37 program improvement, and
38 WHEREAS, Florida’s current Medicaid program is expected to
39 cost more than $20 billion per year, including $5.5 billion in
40 state funds, and will require more than $2.5 billion in
41 additional general revenue to meet current commitments in the
42 next 3 fiscal years, and
43 WHEREAS, additional requirements imposed by the Patient
44 Protection and Affordable Care Act will add nearly another $1
45 billion more to the state’s financial obligation by 2016,
46 require an escalating state financial commitment, and disallow
47 essential means of state fiscal control, and
48 WHEREAS, the performance of Florida’s Medicaid program is
49 undermined by limited physician participation, complex
50 programmatic design, extensive fraud, and inadequate quality
51 controls, and
52 WHEREAS, Medicaid participants are poorly served by a
53 program that cannot deliver coordinated and accessible health
54 care, and
55 WHEREAS, the future of Florida’s Medicaid program requires
56 the delivery of more effective and affordable services to a
57 growing, diverse, and aging population, and
58 WHEREAS, the rebuilding of Florida’s Medicaid program is
59 best accomplished through extension and modification of the
60 current Medicaid reform waiver, and
61 WHEREAS, the Agency for Health Care Administration is
62 negotiating pursuant to chapter 2010-144, Laws of Florida, an
63 extension of the current Medicaid reform waiver beyond its 5
64 year term, and requires additional legislative guidance to
65 successfully complete the negotiation, and
66 WHEREAS, the objectives contained in this memorial are
67 meant to be instructive to the Agency for Health Care
68 Administration in its negotiations for the extension of the
69 Medicaid reform waiver, and
70 WHEREAS, the Florida Legislature intends to transform the
71 Florida Medicaid program into a statewide integrated managed
72 care program for all services, NOW, THEREFORE,
73
74 Be It Resolved by the Legislature of the State of Florida:
75
76 (1) That the Florida Legislature urges Congress to amend
77 Title XIX of the Social Security Act in order to reestablish a
78 fair and prudent federal-state partnership that respects the
79 constitutional requirements and fiscal constraints of each
80 government and enables states to provide cost-effective health
81 care services to low-income residents.
82 (2) That the Florida Legislature urges Congress to
83 restructure the Medicaid program based on the following
84 principles:
85 (a) The federal-state partnership for Medicaid should be
86 modeled on the Personal Responsibility and Work Opportunity
87 Reconciliation Act of 1996, with federal funding distributed
88 based on population and tied to specific goals and objectives,
89 thereby allowing each state the freedom to craft a Medicaid
90 program that meets the needs of its residents.
91 (b) Participants should be empowered to use the public
92 resources provided for their health care to purchase private
93 health insurance when they determine such insurance better meets
94 their needs.
95 (c) A focus on prevention and the cost-effective use of
96 services should be established by fostering personal
97 responsibility and rewarding healthy behaviors.
98 (d) Decisionmaking should be decentralized in order to
99 allow providers and plans to compete to deliver better value to
100 consumers through innovative service packages, organizational
101 forms, delivery systems, and payment methods.
102 (e) Participants should be given every opportunity to
103 achieve optimal health through systematic, transparent, and
104 continuous outcome measurement and quality improvement.
105 (3) That the Florida Legislature resolves, even without the
106 federal reforms described herein, to adopt comprehensive
107 legislation in the 2011 Regular Session to accomplish the
108 following objectives:
109 (a) To improve program performance by expanding key
110 components of the Medicaid managed care pilot program statewide,
111 while strengthening accountability for improved patient outcomes
112 and preserving meaningful choices for participants.
113 (b) To improve access to coordinated care by enrolling all
114 Medicaid participants in managed care except those specifically
115 exempted due to short-term eligibility, limited service
116 eligibility, or institutional placement.
117 (c) To enhance fiscal predictability and financial
118 management by converting the purchase of Medicaid services to
119 capitated, risk-adjusted payment systems.
120 (d) To use the expertise of managed care organizations,
121 including both health maintenance organizations and provider
122 service networks, to provide all coverage and services for
123 medical assistance and long-term care, including home and
124 community-based services.
125 (e) To make the state a more prudent purchaser through the
126 use of regional, competitive procurements to select, based on
127 quality and price, a limited number of managed care
128 organizations, including at least one provider service network
129 in each region.
130 (f) To protect participants’ choices and dignity by
131 expanding the use of the opt-out provisions of the pilot program
132 and allowing Medicaid funds to be used for any state-regulated
133 private coverage, rather than limiting this option to
134 employment-based health benefits.
135 (g) To phase in implementation of the statewide managed
136 care program, allowing adequate time for development of managed
137 long-term care and reserving the final phase of the
138 implementation of managed care for persons with developmental
139 disabilities.
140 (4) That the Florida Legislature resolves to enact reforms
141 that establish a more fair and predictable civil justice system
142 and reduce disincentives for serving Medicaid participants.
143 BE IT FURTHER RESOLVED that copies of this memorial be
144 dispatched to the President of the United States, to the
145 President of the United States Senate, to the Speaker of the
146 United States House of Representatives, and to each member of
147 the Florida delegation to the United States Congress.