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.