Florida got Medicaid waiver but we will have to wait to assess savings

Rick Scott campaigned on a promise in 2010 that one way for Florida to save money was to expand privatization of Medicaid, which provides health coverage for the poor.

Florida first received a waiver in 2005 under Gov. Jeb Bush for a demonstration project in a few counties. Scott sought to expand the waiver statewide.

Without the waiver, the state paid doctors and hospitals directly via Medicaid. The waiver allows the state to pay private managed care organizations, who then coordinate care.

In early 2013, the state and federal government started to reach an agreement for the waiver -- at the same time that Scott announced that he now supported Medicaid expansion. That was a major change of position for Scott (PolitiFact Florida awarded him a Full Flop), but the Legislature refused to expand Medicaid to about 1 million poor Floridians.

The state negotiated two waivers with the federal government: one for patients in long-term care such as nursing homes and another for poor Floridians who need assistance and live on their own, called the Managed Medical Assistance waiver. Both waivers were approved in 2013; the long-term waiver expires in 2016 and the other in 2017. (The state has the option to renew the waivers.)

As for cost savings, the state negotiated a 5 percent rate cut with private providers, which the state Agency for Health Care Administration predicts will save $650 million a year -- which translates to close to $1.9 billion over three years. The bulk of the savings is expected to come from the Managed Medical Assistance waiver.

The long-term care program completed its rollout March 1, 2014, and the Managed Medical Assistance program completed its rollout Aug. 1, 2014, so there isn't enough data yet to evaluate if Florida is on track to save $1.8 billion.

Florida Chain, a group that advocates for affordable health care, said it's not a stretch to believe that the waiver could accomplish the savings.

"However, I think a fair question is whether even more could have been saved over a longer period by setting up a program of managed care that did not rely on for-profit companies to exact savings in order to meet the demands of investors and shareholders," said spokeswoman Leah Barber-Heinz.

She also said it's possible that some savings could be the result of efforts to delay or deny access to care "so front-end savings alone may not provide the full picture."

Scott achieved a big step toward his promise by getting the statewide waiver, but it's too soon for us to evaluate whether he has achieved the savings and the full impact of the program.

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