Issue:  2.7 million Floridians including 30,000+ APD DD consumers will be required to join an HMO, Preferred Provider Networks (PPN) to receive benefits if Governor Crist doesn’t veto the new managed care bill  This will profoundly impact the quality, quantity and choices of services received. 


Read 66 page Bill:(HB 7223 > reconciled Senate/House version). DD section primarily on page 53 line 1471 to page 57 line 1585. 


Who:   Persons with Developmental Disabilities including Medicaid beneficiaries forced to join private manage care companies. 


When:  Managed Care will be phased in over the next 4 years with some changes 7-1-10. “By January 1, 2014, the agency shall begin implementation of statewide long-term care managed care for persons with developmental disabilities, with full implementation in all regions by October 1, 2015.”(line 1480-83)  House bill was heard in only 1 committee (not health committee) and passed all within 7 days (April 12-19, 2010)


Where:  Scope is the entire State of Florida, instead of continuing the current pilot project to ascertain if it really cuts cost and how if effects quality and availability of services. 


How:  The state will be divided into six regions that HMOs and PPNs will operate the managed care of all 2.7 million FL Medicaid beneficiaries.  The state will pay a monthly fee for each Medicaid beneficiary to the HMOs or PPNs instead of a fee for service.


Why:  HMOs and insurance companies have promoted a radical shift away from fee for service delivery system to a Medicaid managed care model that is privately operated with the promise that it will save the state 3% to 15%.  Additional motivation for this change was the $3 billion shortfall in revenues to meet the overall state budget along with the increasing Medicaid costs.  The problem is that the not so certain savings that were promised by HMOs, these savings will actually be used instead to pay for the HMO profits and administration.  


Impact of Change:  Medicaid beneficiaries such as DD Medicaid Waiver consumers will have less choice in selecting their providers.  Support Coordinators and other providers will be eliminated since HMOs / PPNs will hire their own case managers and decide which new cheaper providers to use.  As a result, quality and quantity of services will most certainly decrease since manage care providers have a vested interest in cutting services to maximize their profits.  If you like HMOs, you may like the change. 30,000 people with disabilities and their families including over 2.7 million other voting Floridians will be negatively impacted.  HMOs and PPNs are based on a medical model not on the special needs of DD consumers.  Over 15,000 persons with disabilities will remain on the wait list.  No impact in reducing the wait. There will also be thousands of people that will likely lose their job once implemented since HMOs and PPNs would employ their own people discarding many of the current providers of care.  Billions of state funded dollars may also leave the State of Florida if any of the new HMOs or PPNs are located outside of the state.  How does this change improve Florida’s economy and jobs?


Action you can take:  Get involved now! Contact Governor Crist.  Call, fax (850) 487-0801  email Charlie.Crist@MyFlorida.com  , or write a letter to Governor Crist @:  Office of Governor Charlie Crist State of Florida The Capitol 400 S. Monroe St. Tallahassee, FL 32399-0001.  In addition to telling him in a polite, respectful manner you are against this mandated managed care change, tell him briefly how it will affect you in a very short example.  (A sample letter is below).   Tell as many elderly and disabled people on Medicaid about this and offer to help them contact Governor Crist to veto.  Be sure to thank the governor for his veto protecting the most vulnerable, poor and disabled in addition to standing on principle of opposing the same legislatively manipulated process this bill took as the teacher Merit pay bill. Managed Care bill: Total time in House =1 week, no notice to 2.7 million beneficiaries,

only 1 committee had input and was clearly an abuse of the intended legislative procedure and process. 


Solution: Governor Crist vetoes bill. If reductions in state programs are still necessary to balance budget, then do take across the board reductions instead of managed care bill.  This bill removes choice and capriciously eliminates providers that have in many cases known for years the beneficiaries and their needs.  Eliminating providers such as support coordinators will be removing independent third party advocacy for the most vulnerable, poor and disabled population without a voice. If governor does not veto, at least require HMOs to respect the choice of DD consumer as to whether keep the current support coordinator and other providers.  This demonstrates respect for choice and some continuity. Or instead increase the scope of the pilot study currently underway or allow more time to study the results of the current pilot project to see if it actually works.

Here is how your State of FL Representative voted on this bill.                                              (Info provided is subject to change)

                        S A M P L E    L E T T E R TO  G O V E R N O R   C R I S T

                       “A society will be judged on how it treats its weakest members”.


Dear Governor Crist,                 


ISSUE:  House and Senate Bill Related to Medicaid Reform and Implementation of HMO Management of the HCBS Medicaid Waiver  HB 7723


Question:  Should the State be Divided Into Regions Managed by HMO's and Preferred Provider Networks




I realize you have difficult budget decisions to make. But please DO NOT SIGN the Medicaid Reform Bill.


The House and Senate adopted these bills, written largely if not entirely by a lobbyist for one of the HMO's, without due consideration for the data available from the pilot study of this being conducted in the Miami-Dade area of the state. The reviews from those areas are mixed and hardly conclusive in showing that they improve the quality of life for any of the disabled citizens they are supposed to serve. In fact, there are numerous concerns among a great many recipients of services in those areas regarding the loss of choice and the significant decrease in the quality of services received under the HMO system. These bills were rushed through both the House (introduced in only 1 committee and 1 week later  voted on house floor-does that sound familiar?) and Senate with limited transparency and little deliberation--as if the deals for approval were made well in advance of the readings.   Is this the type of example and values we want to teach our young voters?  The message sent was that the rich and powerful can quickly force a dramatic change on the elderly and disabled without any notice or input from the very people the new law will affect.  


The current system involves the Agency for Persons with Disabilities (APD) playing a significant role in quality assurance and private contract HCBS Medicaid Waiver providers who advocate for the needs of their caseloads working together to get the needs of the developmentally disabled citizens of the state met. It has been working very well and though harsh, the cost containment efforts of this current system are finally showing significant gains while still allowing the State of Florida a good measure of control over the quality of services provided. Surrendering the entire service system over to greedy, profit-hungry HMO entities is NOT the way we want the State of Florida to go. 


If you still are inclined to support this proposal, please first consider increasing the scope of the pilot study currently underway or allow more time to study the results of the current pilot project to see if it actually works.  Make sure this proposal is proved before inflicting this drastic change on more than 30,000 people with disabilities and their families and over 2.7 million other voting Floridians.  There will also be thousands of employees within companies that will likely lose their job once implemented since HMOs and PPNs would employ their own people.  Billions of state funded dollars may also leave the State of Florida if any of the new HMOs or PPNs are located outside of the state.  Will this improve our economy and jobs? 


I am earnestly asking you to VETO the Medicaid Reform Bill and allow the current system with any necessary cost reductions to work. There are NO winners in this bill with the sole exception of HMO's.


Thank you.

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