2010 Legislature                                          SM 4-A
    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.
    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,
   74  Be It Resolved by the Legislature of the State of Florida:
   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.