FEDS REJECT PART OF STATE'S REQUEST FOR MEDICAID CHANGE

By JIM SAUNDERS
THE NEWS SERVICE OF FLORIDA

THE CAPITAL, TALLAHASSEE, February 11, 2012........Taking aim at a controversial piece of Florida's Medicaid overhaul, federal health officials this week rejected hitting beneficiaries with $10 monthly premiums and charges for some emergency-room visits.

The federal Medicaid agency, in a letter dated Thursday, notified the state that the proposals violated federal requirements that are designed, at least in part, to shield poor people from additional costs.

Democratic lawmakers and advocates for Medicaid beneficiaries, such as the group Florida CHAIN, blasted the proposals last year when the Republican-controlled Legislature included them in a massive plan to revamp Medicaid.

Florida CHAIN released a statement Saturday describing the proposals as "too extreme and too dangerous to be given serious consideration.''

"Congress already allows states to require Medicaid recipients to contribute to their care, but there are limits on what states can charge the poorest because they can afford so little,'' the advocacy group said. "Legislative leaders knew that but were unconcerned, repeatedly insisting that they had provided 'a hundred different reasons' for the federal government to approve their request.''

While controversial, the proposed charges were a relatively small part of Florida's move to overhaul Medicaid. The key part of the overhaul would eventually shift almost all beneficiaries into managed-care plans --- an idea that remains under federal review.

Republican leaders argue the overhaul is needed to control costs and to improve fragmented care in the Medicaid system. Critics, however, have long contended that the changes could hurt beneficiaries.

One of the proposals rejected this week by the federal Centers for Medicare & Medicaid Services would have required most beneficiaries enrolled in managed-care plans to pay $10 monthly premiums.

In the submitting the proposal to federal officials in August, the state Agency for Health Care Administration said it was part of a legislative effort to ensure that beneficiaries are "active participants in the program."

"The Florida Legislature intended that eligibility for Medicaid include certain personal responsibilities on the part of recipients,'' AHCA said in the proposal. "The new law includes provisions on participation in activities to promote healthy behaviors and modest financial participation in the program.''

The other rejected proposal would have imposed $100 co-payments on beneficiaries if they go to emergency rooms for non-emergency care. Lawmakers hoped the change would reduce costly emergency-room visits for care that could be provided in places such as doctors' office or clinics.

In Thursday's letter, the federal Medicaid agency said the proposed $100 charges were higher than allowed in federal law. But it also indicated concerns about Medicaid beneficiaries unnecessarily using emergency rooms.

"CMS shares the state's goal of promoting cost-effective use of hospital emergency department services, and we will be happy to work with you to consider alternative approaches to meeting this goal,'' the letter said.