Florida Gov. Jeb Bush's plan to test a new kind of Medicaid coverage in two counties won federal approval Wednesday.
U.S. Health and Human Services Secretary Mike Leavitt approved the state's application for a Medicaid waiver, which still needs final endorsement from the Florida Legislature.
But with that support expected to come easily, the governor and Leavitt said the changes could now be seen as a national guidepost toward ending the 40-year tradition of treating Medicaid as an entitlement for the needy.
"This will be a part of a national debate about how to create a more sustainable Medicaid program," the governor told reporters on a conference call from Washington.
His plan calls for shifting coverage for the poor, disabled and elderly residents from Medicaid to managed care.
The governor and other backers said the federal authorization was a major step toward controlling costs and guaranteeing better health for patients.
The changes will begin in July with 210,000 people in Broward and Duval counties.
Gov. Bush, who joined Leavitt in Washington for the announcement, said he hoped to get legislators' blessings during a special session in December.
Several health and insurance groups, including the Florida Assn. of Health Plans and the Florida Hospital Assn., hailed Wednesday's approval as a major reform. But some consumer groups reacted with muted optimism or criticism.
Leaders of AARP Florida, an advocacy group for seniors, said they didn't think large managed-care companies could necessarily be trusted to look out for low-income Floridians.
The five-year program is designed to control costs by capping per-patient expenditures. It will eventually take in all 2.2 million Floridians covered by the federal-state Medicaid program.
The state will pay a "risk-based" premium linked to a recipient's health status.