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Scott advisors urge new gov to tackle Medicaid's 'financial storm'

Medicaid reform should be such a top priority of Florida's new governor that he should consolidate all Florida's health care agencies to do it and use his first state of the state address to talk about the dangers of the ''financial storm ahead'' caused by the exploding Medicaid budget.

Those are some, but not all, of the very specific recommendations delivered to Gov.-elect Rick Scott by his health care transition committee on Monday. Scott, who takes office on Jan. 4, is meeting in Fort Lauderdale this week with the leaders of his six transition teams.

By consolidating the health agencies, Scott would reverse the work of Gov. Lawton Chiles 20 years ago, who pushed for the separation of the state's massive Department of Health and Rehabilitative Services into the Agency for Health Care Regulation, the Department of Children and Families and, later, the Department of Elder Affairs, the Department of Health, and the Agency for Persons with Disabilities.

   Scott's health care advisory team recommended consolidation of all those agencies, with the exception of the child welfare focus of DCF, into a large Department of Health and Human Services, according to the 68-page report released on Monday.

   The goal of the mega-agency would be to better coordinate overlapping functions now handled by the single-mission agencies as the state attempts to reform the delivery of Medicaid services.

   The Health and Human Services Transition Team contained 45 members but bears the reformist voice of Alan Levine, who helped shepherd the Medicaid reforms first implemented by former Gov. Jeb. Bush. The team was charged with îîfinding ways to lower health care costs, transform the delivery of health services and better meet the needs of those most vulnerable in the state'' but the most sweeping proposal calls for changing how the state delivers Medicaid and urges a continuation of many of the programs advanced by Levine under Bush.

   Levine, who was also once head of the North Broward Hospital District and formerly served as Health and Hospitals secretary under Louisiana Gov. Bobby Jindal, urged Scott to hire a "quarterback'' in his office who could coordinate health policy and management and “be capable of working closely with the legislature."

   Levine predicted that consolidating so many agencies would take îîat least a year to plan and implement'' but was needed to improve policy coordination.

   The Department of Health Transition team, headed by Jason Rosenberg, a medical doctor, had harsh criticism of the Department of Health, saying it lacked leadership and a sense of mission. It echoed the call for agency consolidation and suggested that the state should get out of the business of allowing county health departments to provide primary care when other facilities are available in a region.

   Rosenberg's committee also recommended merging the Agency for Health Care Administration with the Department of Health and recommended closing AG Holly tuberculosis hospital in Palm Beach County. The team also likes the idea of asking private, for-profit entities to run now-public functions. Among the functions the report recommends the governor steer to the private sector: health care licensing, health education programs and the operation of the states three mental health hospitals in Macclenny, Gainesville and Chattahoochee.

   Other recommendations:

   * Merge the Agency for Persons with Disabilities with the Department of Elder Affairs and have it be a division within a larger health and human services agency.

   * Keep child welfare programs separate from  a larger health department.

   * Continue to fight for repeal of the federal health care reform act because it is "very costly for Florida at the very time we cannot even afford to operate the Medicaid program in its current form.''

   * Expand Medicaid reform from the pilot projects in Miami-Dade, Broward and three other counties to statewide.

   * Adopt Medicaid reform that includes an "organized, coordinated network'' of care for the elderly that uses the private sector to give people "services they need'' and not necessarily "services they want.'' The state would be responsible for providing îîproper oversight to ensure needed services are not systemically denied.''

   * Give doctors immunity for treating Medicaid patients.

   Scott on Monday also received a report on regulatory reform and today and Wednesday will receive reports on education and prison reform and how to shrink the size of government.