Dentists and hospitals are wary of lawmakers' proposed Medicaid changes

Florida House members Monday backed a proposal that would revamp the managed care system that serves about 4 million Medicaid beneficiaries, but key parts of the plan are fueling opposition from dentists and hospitals.

Lawmakers are considering changes as the state Agency for Health Care Administration prepares to move forward with a process to award a new round of contracts worth billions of dollars to HMOs and other managed-care plans.

Perhaps the most controversial part of the House proposal (HB 7047), which was approved Monday by the House Health Care Appropriations Subcommittee, centers on how dental services would be provided to Medicaid beneficiaries.

The bill, sponsored by Rep. Sam Garrison, R-Fleming Island, would bring those dental services under the umbrella of the managed care plans. That would effectively undo a 2016 decision by the Legislature to create a separate Medicaid managed-care program for dental care — known in Tallahassee as a “carve-out” of the services.

The proposed change has drawn opposition from dentists, with Joe Ann Hart, chief legislative officer for the Florida Dental Association, telling the House panel that it would create administrative barriers that could make dentists less likely to treat Medicaid patients.

“The worst part about this that we don’t want to see is that it will create a disincentive for dentists to participate,” Hart said.

But Garrison said he looks at the issue from a “standpoint of, ultimately, what’s going to provide the most comprehensive care for our dental patients at the lowest possible cost to the taxpayer, especially in situations where you have a Medicaid population, a number of them with unique health-care challenges that oftentime require a high level of integration between the dentist in the chair and the folks at the ER and the hospitals.”

“In my conversations with the folks on all sides of this debate, I don’t see whether you have a carved out dental plan or an integrated dental plan as being the issue that’s going to be dispositive about whether or not dentists and their practices are going to participate in Medicaid,” he said.

After testing a pilot program, lawmakers in 2011 created a system in which most Medicaid beneficiaries are required to enroll in managed care plans. As of the end of December, about 3.98 million of 5.06 million Medicaid beneficiaries received care through such plans, according to data posted on the Agency for Health Care Administration website.

The agency has gone through lengthy processes twice to award contracts to managed care plans and is expected to begin a third round this year.

Parts of Garrison’s bill would make changes in the contracting framework. For example, in the past, the agency has awarded contracts in 11 regions of the state; the bill would whittle that to eight regions. Also, the bill would revise minimum and maximum numbers of contracts that would be awarded in each region.

But the proposed dental change and a proposal that would affect what are deemed “essential” Medicaid providers have drawn the most attention.

The Florida Hospital Association and the Safety Net Hospital Alliance of Florida, the two main lobbying groups for the hospital industry, voiced opposition Monday to the proposal related to essential providers, which could include, for example, public hospitals and teaching hospitals.

Under the bill, those providers would be required to contract with each Medicaid managed-care plan in their regions and, in some cases, throughout the state. They would face the possibility of losing what are known as “supplemental” payments if they don’t have such contracts.

Garrison said current law requires AHCA to essentially serve as a “referee” in contract disputes between the providers and managed-care plans.

“Quite frankly, I think that puts AHCA in an untenable position,” he said. “It’s the Agency for Health Care Administration, not the Agency for Health Care Dispute Resolution. So what we’re trying to do is get them out of the business of picking winners and losers and saying, ‘Yes, this is good faith,’ or ‘No, this is not good faith.’”

But Rep. Kamia Brown, D-Ocoee, said the proposed penalties for providers that don’t reach agreements with managed-care plans are “outrageous.”

“I’m trying to figure out what specifically is in place to make sure everyone comes to the table in good faith,” she said. “It seems as though you are sort of strong-arming one (side), but then could possibly not get into a good contract that is conducive.”

The bill, approved in a 10-5 vote, would need to clear the House Health & Human Services Committee before it could go to the full House.

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