Oklahoma’s dynamic Medicaid discussion includes Florida pilot program

OKLAHOMA CITY – This week, even as Oklahoma got a major slap-down from President Barack Obama’s health care regulators state policymakers began to look at dynamic market-oriented reforms taking hold in at least three states — changes which have secured federal waivers from Medicaid administrators. 

Florida’s Foundation for Government Accountability (FGA), with the help of the Oklahoma Council of Public Affairs (OCPA), organized a May 8 seminar for Oklahoma legislators to highlight reforms in the Sunshine State,  and in Louisiana and Kansas.

In those states, market forces are being used to improve medical care for Medicaid recipients, at lower costs to taxpayers, advocates say.

“Star” of the state Capitol seminar was a triple-amputee who encouraged legislators to create an Oklahoma version of what is called a “new Medicaid” model.

Moise Brutus, now a college student in Florida, lost both legs and part of his left arm in a 2010 motorcycle accident. He endured months of frustration when his recovery was supervised by what he deems “Old Medicaid.” 

Brutus, the subject of a five-minute video posted online recalled that traditional Medicaid “kept giving me bad prosthetics, and those kept breaking.” When his case was transferred to WellCare, part of the “Medicaid Cure” pilot program in Florida, things changed for the better.

His care administrator, Catherine Martinez, transformed his therapy and health regimen. For starters, “They got the prosthetic right in the first place.” He believes his change in fortune was driven by the difference between a “one-size-fits-none” mindset, and the dynamic, competitive approach available in Florida’s “Medicaid Cure.” 

Brutus said, “The government helped me get on my feet, yes. To me, the object is to move away from, to get off, government dependency.”

He continued, “There are others like me who can’t better themselves within the systems where there is no flexibility. I think the idea is to get people to a point of caring for themselves.” He told the Oklahomans he is now at that point.

Concerning defenders of standard or “Old Medicaid,” Brutus asserted, “from my point of view it hasn’t worked, and it’s not going to work. So, it’s time to try something new. I’m going to school, then I’m going to get a job, then I’m going to pay taxes.

“I’m already giving back with involvement in bicycle races to support this cause. I see myself, in five years, having the horizon open to me. Whatever happens in my life will be good. Who knew this could turn out so well for me?”

FGA arranged Brutus’ visit to Oklahoma. The group has described traditional Medicaid structures as embodying a top-down “pay and chase” structure (i.e. pay claims, chase fraud) without the discipline of market competitiveness among providers. 

Tarren Bragdon, FGA’s president, said the Florida pilot program, which began in 2005 under former Gov. Jeb Bush, incorporates choice, customized benefits, incentives for health rather than the convenience of providers, and accountability for all actors in the system – including plans, providers and patients.

Pivotal to the “Medicaid Cure” program is that patients (consumers) can choose among competing managed care businesses.

Spending in the “Medicaid Cure” counties runs nearly $700 per person less than in the state’s traditional Medicaid programs, Bragdon reports. Florida officials estimate $118 million in system-wide savings have already been achieved, and projects that more than $900 million a year could be saved when the reform model is expanded statewide. 

This week’s presentation included, via telephone, Maddie McAndrew, administrator of Louisiana’s “Bayou Health” program patterned on the Florida reforms.

McAndrew said the early transition away from traditional Medicaid, which began just over a year ago, “was chaos, but now it’s working. Our emphasis has included risk adjustments for each recipient.” McAndrew said the program is succeeding, as it did in the Florida program, because administrators have listened “to the stakeholders — the patients, the providers.”

The managed-care programs from Florida, Louisiana and Kansas, focused on Medicaid-eligible populations, are the basis for House Bill 1552  in the Oklahoma Legislature. 

Insurance programs within the envisioned Oklahoma system would include long-term care, allowing some distinctions between urban and rural care systems. While the legislation will not advance in this legislative session, it remains a “live round” and could provide a vehicle for changes to Oklahoma’s system in 2014.

Among the two dozen legislators who met with Brutus and leaders of FBA were state Sen. AJ Griffin, R-Guthrie, a co-sponsor of H.B. 1552.

You may contact Patrick B. McGuigan at Patrick@capitolbeatok.com and follow us on Twitter: @capitolbeatok.