In the wake of the presidential election, state governors must decide whether to take federal funding to expand their Medicaid programs. The U.S. Supreme Court decided in June states can reject the Medicaid expansion without losing access to their previously negotiated matching funds. According to Louisiana Gov. Bobby Jindal, incoming head of the Republican Governors Association, states are deciding whether to use the Court’s decision as political leverage to gain more flexibility to reform their programs.
“There are things you can do with premium support within the Medicaid program that can make it a lot more flexible, market-based and more efficient and conducive to the needs of individuals,” Jindal recently told reporters in Las Vegas.
Chief among reforms that have shown improved quality of care and cost savings is Florida’s pilot program, highlighted by the Foundation for Government Accountability (FGA) as the “Medicaid Cure.” A little more than six years ago, Florida Gov. Jeb Bush established a pilot program in five large counties in Florida with a total overhaul of Medicaid. Under the pilot program, more than 300,000 Medicaid recipients—bigger than the total programs in 17 states—were given the choice of a wide variety of plans created by multiple insurers.
“We never could estimate the costs of a fee for service Medicaid program,” Bush said. “All the incentives were aligned that would create a health insurance system that would not deliver the quality of care we wanted, didn’t create the consumer support that people would want, and always seemed to come in at a bigger number than what was budgeted.”
Premium Support for Medicaid
According to Bush, a Republican, the program resembled what is now referred to as a “premium support” model, in which Medicaid recipients were given a range of premiums and plans to choose from.
“In effect we created a range of premiums based on sound actuarial history for Medicaid patients,” Bush said. “They’d have choice counseling, so they had an array of choices to ch