Aug. 28--The four largest health plans in Florida's Medicaid reform experiment are dropping out, forcing more than half of 204,000 affected patients to change insurers and possibly doctors.

The four -- WellCare's HealthEase and Staywell plans, United Healthcare and Amerigroup -- have given written notice to the state that by Dec. 1 they will withdraw from Broward County and some of four other counties in the Jacksonville area participating in the experiment.

The reform started two years ago to save the state billions and also improve health care for low-income people with Medicaid, by switching them into HMO-style plans. Patient advocates have blasted the reform for restricting care.

Officials from competing plans said the four are getting out fearing they can't make enough money. State payment rates under reform are falling this year, after two years of being phased in.

"What it comes down to is a question of revenue and expenses," said Steve Matthews, a spokesman for United Healthcare. He declined to elaborate. United is dropping out in Broward and may drop out in the other counties. Officials from the other plans did not respond to requests for comment.

The reform covers 116,250 people in Broward, 57 percent of whom are in the four plans. Health officials said the patients could be absorbed by 13 remaining plans in Broward. The Florida Agency for Health Care Administration, which runs Medicaid, said in a statement it was working to ensure patients still have "a meaningful choice of plans."

One patient advocate, attorney Anne Swerlick of Florida Legal Services, said she feared the state would be hard pressed to switch so many people into new plans.

"The potential for chaos is huge. I fear people are going to get hurt," Swerlick said.

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