11:41 AM EDT, Oct 22, 2005 Read more comments or post your own Florida is at the forefront ... Model for others...

Florida is at the forefront of reform with the federal government's approval of Gov. Jeb Bush's ambitious and innovative Medicaid reform plan.

Other states will be watching carefully as Florida sets out to prove that free-market solutions can be brought to bear on the Medicaid crisis that has been consuming state budgets across the country. It is a plan that honors Medicaid's vital role in providing the poor and disabled the health care they need, while protecting taxpayers against fraud and waste.

The only thing timid about this proposal is that the Legislature, particularly the Florida Senate, opted to roll it out as a demonstration project in just Broward and Duval counties. It is set to be phased in over a five-year period, but Florida's poor would be better served if lawmakers could be as bold as Mr. Bush and speed broader implementation of this groundbreaking reform.

Perhaps it is not too late. Mr. Bush will call lawmakers back in December to implement the plan that won a rules waiver Wednesday from U.S. Health Secretary Michael O. Leavitt. It will be another opportunity for the Legislature to embrace this chance to rein in Medicaid costs that have skyrocketed from 10 percent of the state budget a few years ago to just over 25 percent.

That incredible growth -- averaging 13 percent a year over the last six years -- has been repeated in states such as Kentucky, Georgia and South Carolina, which are set to follow in Florida's footsteps.

Under Mr. Bush's plan, Florida would stop being a health-care manager and become a health-care consumer, using its considerable purchasing power to shape the private health-insurance market. Medicaid recipients will be enrolled in managed-care plans, similar to those that currently serve millions of middle-class Americans. By paying a monthly premium for each beneficiary, the state can curb costs and bring predictability to Medicaid spending.

Critics argue the plan could cut services to the poor, particularly children. But the numbers don't show that, given that most providers will now be able to tailor benefits for different groups, such as people with AIDS and children with chronic illnesses. That's important because adults consume the most of Medicaid dollars -- children account for less than 20 percent of costs even though they make up half of the recipients.

And this plan provides Medicaid recipients more choice, including opting out of Medicaid altogether in exchange for subsidies to help pay the employee's share of the premium for employer-sponsored health insurance. It protects the uninsured with a federal-state fund to help hospitals treat them.

These ideas can change the face of Medicaid in America. Mr. Bush has already won praise for this innovation. Now it is up to the lawmakers to see these ideas take hold and flourish.

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