Florida, Vermont, Hawaii, Maine make sweeping health care changes

As some state legislative sessions begin drawing to a close, news outlets report on major changes in health care. Florida is overhauling its Medicaid program, Vermont passed a modified "single payer" bill, Hawaii is trying a "medical home" model and the Maine legislature has a new approach to insurance sales in the state. 

The Associated Press/Miami Herald: Fla. Lawmakers Pass Historic Medicaid Overhaul 
Two historic bills enacting sweeping changes to Florida's Medicaid program won Senate and House approval Friday, placing the care of nearly 3 million beneficiaries in the hands of private companies and hospital networks. ... Sen. Joe Negron, who spearheaded the overhaul, said leaders have learned from the pilot program's shortcomings and includes increased oversight and more stringent penalties, including fining providers up to $500,000 if they drop out. ... "Patients are in charge, doctors are in charge. We want to work to keep costs down," said Negron. ... "You know these people don't have money. How is this a good plan for poor people and are we really looking out for these people's best interest? No, I don't think so," said Rep. Charles Chestnut, D-Gainesville, who voted against the bills (Kennedy and Kallestad, 5/6). 

The New York Times: Florida Legislators Pass H.M.O. Plan for Medicaid 
If signed into law as expected, the bill will make Florida, with one of the largest number of Medicaid patients and a high rate of uninsured, one of the biggest states to jump almost entirely from a traditional Medicaid payment system into managed care. The wholesale shift would begin in July 2012. The bill, a compromise between the House and the Senate versions, would allow the state to decide how much to spend on Medicaid each year, share in the profits of managed-care companies if they exceed 5 percent and penalize networks that reneged on contracts (Alvarez, 5/6).

Reuters: Florida Reforms Health Care For The Poor To Save Money 
The bill would split the state into 11 regions and allow managed care companies to compete for business within those geographic boundaries. ... Like other states, Florida's Medicaid tab continues to gobble up a greater percentage of state spending and now accounts for nearly a third of the state's $69.7 billion budget. While the federal government pays about 60 percent of benefits, the state's tab has also risen and backers fear the state's share of payment could go up if the federal match returns to historic levels (Peltier, 5/7).

News Service of Florida: Legislature Send Massive Medicaid Overhaul To Scott
But even if [Gov. Rick] Scott signs the bills, they still face a major hurdle: The federal government, which pays more than half of the Medicaid program's costs, would need to sign off. Florida will have to seek what is known as a Medicaid waiver to carry out various parts of the overhaul. But that can be a long and complex process, as evidenced by a still-pending waiver request that the state filed last year to continue a pilot managed-care program. Democrats focused, in part, Friday on issues that will get federal scrutiny. As an example, the plan would seek federal approval to require beneficiaries to pay $10 a month in premiums and to impose $100 co-payments on beneficiaries who seek non-emergency care in hospital emergency rooms (Saunders, 5/6).

Related, earlier KHN story: Insurers Clash With Health Providers As States Expand Medicaid Managed Care (Galewitz, 4/27).

Boston Globe: Vt. Seeks Insurance For Most Residents 
As soon as 2017, Vermont could become the first state to provide and pay for insurance for most of its residents under a plan passed by the Legislature Thursday. But it must first clear several significant hurdles, including persuading the federal government to allow the state to assume responsibility for Medicare and Medicaid enrollees and finding a way to pay for the program. The bill outlines a planning process for implementing what is often referred to as a "single-payer'' system (Conaboy, 5/7). 

Medpage Today: Vermont Passes Universal Healthcare Plan
However, residents don't have to enroll in Green Mountain Care (but they do have to have insurance under the [health law]). They can keep the insurance they have now, or they can enroll in Green Mountain Care and buy supplemental insurance from private health insurers. The single-payer advocacy group Physicians for a National Health Program (PNHP) has said the plan is not a true single-payer model because it still allows a role for private insurance companies, and patients would continue to face copayments for medical treatments. ... It's not yet clear how the bill will be paid for (Walker, 5/6).

The Associated Press/Business Week: Vt. Governor Hails Achievements As Session Closes
Vermont Gov. Peter Shumlin is praising Vermont lawmakers for balancing the budget without raising broad-based taxes and for passing an ambitious health care bill designed to move the state toward a publicly financed system that provides coverage to everyone. The governor made the remarks as the House of Representatives wrapped up its business for the year early Friday evening (5/6).

Related, earlier KHN story: Vermont Gov. Proposes Single-Payer Health Plan (Miles, 2/8).

Honolulu Star-Advertiser: State's New Medicaid Plan Is Aimed At Improving Care
State officials unveiled yesterday a new way of providing and coordinating health care for Medicaid patients, particularly the chronically ill, starting in January.  Called "medical home model," the program integrates primary health care, behavioral care and social services for Medicaid recipients ... A key component is an electronic health records system to allow easy access to a patient's medical records wherever the patient goes in Hawaii. One in 5 Hawaii residents is a Medicaid recipient, state officials said (Fujimori, 5/7).

Maine Biz: House OKs Health Insurance Changes
A bill that proposes overhauling the state's health insurance regulations moves to the Senate after narrowly passing in the House. The House yesterday voted 76-72 in favor of LD 1333, which would allow out-of-state insurers to sell health care insurance in Maine and allow insurers to vary premium ratings based on factors such as geographic area and age ... Democrats pushed against the bill, arguing it would increase premiums for older residents and those in rural areas, and said the process was rushed, according to the paper (5/6).

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.