Evaluating Florida's Medicaid provider services network demonstration.

State policies and actions are an integral part of our nation's health policy framework. This is particularly obvious in the case of Medicaid, a program for which the states share fiscal obligations and have primary administrative responsibility. Concerns regarding the quality of care provided to enrollees and the financial viability of Medicaid programs in the states are among today's “hot topics” in the health policy arena (The Kaiser Commission on Medicaid and the Uninsured 2006). While the issues are not new, the current conversation may differ from those of previous years because the contemporary political and policy context includes serious consideration of much greater state flexibility in the structuring of Medicaid and the delivery of health care to Medicaid enrollees (Finegold, Wherry, and Schardin 2004; Rowland et al. 2006). At present, a great deal of state interest is focused on moving Medicaid payment systems toward a more intensely managed form of managed care (Bailit, Burgess, and Roddy 2004; Kaye 2005). In considering and pursuing the opportunities deriving from increased flexibility, states frequently begin with overall philosophical preferences and then review past experiences to focus their efforts on Medicaid policy initiatives that are consistent with those preferences and have some demonstrated promise of success. To a significant degree, the observation of prior experience is focused on the outcomes of demonstrations that have been implemented with the authority of a Section 1115 Waiver. While the Deficit Reduction Act of 2005 (DRA) may create new and increased avenues for states to pursue program variation, the historic purpose of waivers has not simply been to change programs, but to test ideas or new approaches to program implementation. Formally, they are “Research and Demonstration Waivers,” explicitly acknowledging the role of observation and research as to the impact of the demonstration. The research part of this function is not always achieved, because that aspect of waiver-based Medicaid program changes typically takes a back seat to program implementation. Furthermore, except for privately funded initiatives such as the State Coverage Initiatives Program (http://www.statecoverage.net) and the State Health Access Data Center (http://www.shadac.umn.edu/), there is no convenient clearinghouse for systematically disseminating demonstration research findings that might prove valuable for subsequent program modifications or to other states as they contemplate policy interventions. Effective July 1, 2006, Florida embarked on a 5-year research and demonstration project that may significantly change its Medicaid program. One element of the Florida reform initiative is the inclusion of provider service networks (PSNs) among the managed care organizations that may be used to organize and deliver care to Medicaid enrollees. The decision to include PSNs in the 2006 reform initiative is explicit in both the enabling legislation (FL Gen. Laws ch. 2005-358 [2005]) and in the state's waiver application. Absent such inclusion, PSNs would not be part of the current reform initiative. The decision to include the PSN option in the current reform initiative derived, in part, from the evaluation research findings from a previous Medicaid demonstration. The purposes of this article are to describe key findings from that prior evaluation and to note the linkages to Florida's current Medicaid Reform initiative.