Visitors from the East bear gifts of Medicaid Reform

Christie Herrera of Florida’s Foundation for Government Accountability described Medicaid spending as the Pac-man of the Sunshine State’s budget, because it threatened to “eat up everything else.”

But new pilot project reforms, already saving the state $118 million a year, might save a billion annually if implemented statewide.

Herrera’s colleague, foundation CEO Tarren Bragdon, said Oklahoma could save as much as $770 million annually if policymakers here followed the trail blazed in five Florida counties.

Their message got the attention of the Oklahoma Council of Public Affairs, which last week arranged meetings for the Floridians with several legislators and some state health system officials.

It’s no mystery why the Oklahomans are paying attention.

In the most recent budget, the Legislature approved $80 million for “maintenance of effort” in Medicaid. A third of that was pulled from the Insure Oklahoma fund, an insurance program to help the state’s working poor.

The state’s Medicaid spending challenges are historic, and intensifying. Oklahoma’s 2001 Medicaid spending totaled $2 billion, of which the state contributed about $495.5 million. Last year, that program cost $4.4 billion, of which the state contributed nearly $1.3 billion.
Three states — Louisiana, Texas and Kansas — have begun to implement the Florida model. Each state has limited itself to pilot programs, but discussion about statewide expansion is intensifying in Florida.

In an interview for CapitolBeatOK’s weekly podcast, Bragdon sketched his state’s experience.

Until 2005, Florida and then-Governor Jeb Bush “faced the exact same dynamics that every state, including Oklahoma, is facing today — an unsustainable Medicaid program,” Bragdon said. It was what critics call “a pay-and-chase system, where government paid claims [and] chased after fraud, but nobody thought about this: ‘Is Medicaid what Medicaid should be, from the start — which is an effective health program, to move patients who are poor and sick to better health and on to a better life?’”

Beginning in 2006, in at least the five-county area (Ft. Lauderdale, Jacksonville and surrounding rural areas) Florida moved away from its “one-size-fits-none” Medicaid program, as Bragdon dubbed it.

Herrera is a kind of evangelist for the Florida reforms, with its documented improvements in health outcomes in the pilot program. She opposes expansion of traditional Medicaid under the Affordable Care Act.

“When you talk about an open-ended Medicaid entitlement that is unsustainable, states are going to have to do something,” she said. “So, why not go with a proven reform like Florida’s that has shown to not only save money but also make patients healthier?”

Despite their critical views of the Obama Administration and its health insurance mandates, the pair of Floridians credited federal renewal of waivers that allowed the five-county experiment to continue. “We can’t predict the future,” Herrera said. “We have to make sure that all of our bases are covered, regardless of who wins in November.  The Florida Medicaid reform is something the states can do, regardless.”

Bragdon observed, “Regardless of who wins in November, either Medicaid is a really huge problem, or it’s an even bigger one.”

Jonathan Small, fiscal analyst at the OCPA, considers the Florida reforms “promising” for having “refocused Medicaid on its best purpose, which is to meet the medical needs of those who truly need help, bringing them toward better health and into an insurance market that is economically sustainable for them and for taxpayers.”

Podcast moderator Billie Rodely dubbed the Floridians “visitors from the East.”

In Small’s view, they were visitors bearing gifts — policy ideas that could save Oklahoma hundreds of millions of dollars a year.

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

Note: The “Capitol Watch” podcast team includes Rodely, this writer and Peter J. Rudy.