Florida's Medicaid program faces a massive reshaping as legislators grapple with a $2 billion budget deficit for the program. The Legislature is considering two options for the $18 billion program — one expanding mandatory managed care for 375,000 beneficiaries in some of the state's largest counties and the other a patient-centered medical home pilot. As they determine the future of Medicaid, legislators may also change the benefits that they, state employees and dependents receive. Looking to save costs, the state may do away with its fully insured HMO option that has richer benefits and rising costs. In addition, UnitedHealthcare has implemented a mail-order program for 18 common chronic care drugs for its fully insured members as part of efforts to control costs for its risk-based pharmacy clients. Statewide, commercial health plans continue to see slipping enrollment, but consumer-directed health plans have seen increased interest. Blue Cross and Blue Shield of Florida has shifted all of its employees to health savings accounts and the HSA has experienced growth in self-funded groups, but state rules over rates have impeded much of the gains possible in fully insured plans.