Simply Not A Simple Extension

 AHCA must submit the request for an extension to the federal Centers for Medicare and Medicaid Services (CMS) next month. 

While there are legitimate reasons to consider continuing parts of the experiment, advocates have insisted  that doing so without fixing the many unresolved problems is far too risky. 

But why is a simple extension of such great concern? Because the issues linked with this extension are anything but simple:
 
1.            Medicaid Reform involves much more than expanding Medicaid managed care.

The most-discussed component of Reform is the requirement to enroll in a managed care plan. However, the Reform Pilot includes many other components, some of which simply haven`t worked and a few dangerous ones that can't work.  Most importantly, HMOs were given a new level of flexibility that they so far have used to evade accountability and to delay and deny access to care. The experiment is designed around the interests of plans, not patients.  In fact, the Legislature could expand Medicaid managed care even if the Reform Waiver were not extended.

AHCA, however, has been an ardent supporter of Medicaid managed care. The Agency has been laying the groundwork for a smooth path to extension of the Waiver throughout the year. They have continuously downplayed or ignored the concerns while painting the rosiest picture possible and misrepresenting the real situation.
 
2.       Extending the Waiver doesn’t postpone the end of the 5-county experiment. Rather, it sets the stage for it to be a permanent fixture statewide.
 
The current Waiver calls for Reform to expand statewide, and some form of expansion has been proposed in each of the last 3 legislative sessions.  Furthermore, as significant as the concerns are with the current Pilot, an even more troublesome proposal from last session would have forced virtually every Medicaid recipient into managed care. That would have included recipients that are so vulnerable that they currently cannot enroll in an HMO.  A much bigger experiment like that would almost certainly be built on top of the current Reform experiment.
 
3.           Reform's supporters are anxious to proceed before too many facts are considered.

First, the current process to request the Waiver extension is rushed, and it's clear that the problems won't be addressed. The Legislature did not address the need to make changes in the Reform Waiver. However, much has changed since 2005. It is clear that amendments will be necessary if the initiative is to continue. AHCA would almost certainly prefer to negotiate those behind closed doors. Second, the extension request precedes real analysis of the years-delayed patient encounter data. That data was supposed to tell us what is really happening in the Medicaid system. Finally, this type of Waiver is granted for "research and demonstration" purposes. The more attention paid to the original questions asked and whether the experiment can meet its stated goals, the clearer the need for an overhaul would be.

It's true that any extension of the Waiver will affect thousands of recipients in the short term. However, it will just as likely severely impact millions throughout the state for years to come.