A crucial experiment in the future of Medicaid is playing out in Florida, where both houses of the Legislature are vying to find ways to drastically cut costs, manage care and reduce waste and fraud. The cuts and changes being sought by the Republican-led Legislature and encouraged by the new Republican governor, Rick Scott, a wealthy former hospital company executive, are deeper than those in many other states. Relying loosely on a five-year-old pilot program to shift care to H.M.O.'s, Florida lawmakers are poised to scrap the traditional model in which the state pays doctors for each service they perform. Instead, almost all of Florida's Medicaid recipients would be funneled into state-authorized, for-profit H.M.O.'s or networks run by hospitals or doctors. H.M.O.'s or networks would also manage the long-term care of the elderly, shifting them away from nursing homes and leading to an expansion of in-home care.
