Tense meetings as Florida Medicaid overhaul continues

Broward County Medicaid patients begged state health officials Thursday not expand a privatization program they say failed miserably in their county and prevented them from getting medications and doctor appointments.

Doctors also complained the treatments they prescribed were frequently denied and said low reimbursement rates made it difficult to continue seeing Medicaid patients under the five-county pilot program that began in 2006.

State health officials held meetings across Florida this week after the Republican-led Legislature passed two historic Medicaid bills that place the care of nearly 3 million beneficiaries in the hands of private companies and hospital networks. Supporters say they have revamped the program to include more oversight in the new bills.

Lawmakers said Medicaid’s roughly $21 billion annual costs were overwhelming the state budget and promised privatization would rein in costs and improve patient care.

The two-year implementation begins July 2012. Long term care patients, who were not included in the pilot program, will be the first to enroll.

Federal health officials have yet to sign off on the proposal. They signaled earlier this year they would not approve an expansion of the pilot program unless it addressed transparency, accountability and quality of care issues.

Here’s how it works: Doctors and other providers are currently reimbursed by the state for each service they deliver. Under the new program, the state will give for-profit companies a flat fee and allow them to determine what treatments and medications will be covered.

Critics worry the state is abdicating care of its most vulnerable residents to for-profit companies with little oversight of whether the money is being spent on patient care or administrative costs. State health officials have said they do not have a record of what services and medications were denied under the pilot program.

Fifty-six year-old Danuta Jalik slowly made her way to the microphone with the help of a walker and told state health officials she has two books with the names of doctors and specialists she can’t see because they don’t take Medicaid patients.

“I wake up in pain and I go to bed in pain every night and I cannot get help,” said Jalik, who has undergone half a dozen surgeries on her spine and partial lung removal.

Supporters say they have addressed the pilot program’s shortcomings. For example, providers can be fined up to $500,000 if they drop out. The measures also increase doctors’ reimbursement rates and limit malpractice lawsuits for Medicaid patients in hopes of increasing doctor participation in the program.

The bills removed a requirement for plans to spend certain percentages on patient care and administrative costs. Federal health officials encouraged state lawmakers to include that provision in the bill.

Instead lawmakers created a profit sharing plan, requiring providers to generate a 5 percent savings the first year, which could save the state about $1 billion.

Attorney Pamela Burdick warned of “granny dumping,” forcing residents out of nursing homes under a provision that “creates a profit incentive for managed care plans to push seniors out of long term care.”

Sen. Joe Negron, who spearheaded the overhaul, called granny dumping “complete fiction, with no basis in fact or law.”

State health officials will not allow managed care providers “to force any nursing home resident into another form of care if the resident needs to be there,” Negron said in an e-mail.

The legislation favors home and community based setting over institutional placement whenever possible, said Shelisha Coleman, a spokeswoman for the Agency for Health Care Administration. She said the agency will closely monitor long term patients to make sure they are getting appropriate services.

Daniel Brady of Miami Jewish Health Systems, which oversees hundreds of nursing home patients, worries about payment delays under the overhaul. He said it takes about 90 days for patients to be deemed eligible for nursing home or other services. Nursing homes take the patients into the facility anyway and are later reimbursed for the three months under the current Medicaid system in Miami.

But some managed care plans are notorious for not paying claims and nursing homes can’t eat the costs, Brady said.

“What’s going to happen is nursing homes aren’t going to take (the patients) in the first place,” he warned.

Several doctors and health care providers testified Thursday about plans denying all their treatments. One provider said they hadn’t received payment from a managed care plan in one year.

Several managed care plans, including United, dropped out of Broward County because they couldn’t turn a profit, leaving patients scrambling to find another provider. Federal health officials said nearly half of the 200,000 patients enrolled in Florida’s pilot have been dropped from at least one plan. Many have been bounced between several plans.

A United spokeswoman who attended the hearing said they will work with the state to maximize resources.

Under the new statewide program, the state will also terminate that plan’s contracts in other areas if they pull out of one region.

“We refuse to eliminate any care that the members deserve to have … regardless of whether we are doing good or bad financially,” said Eurica Sadler, vice president of finance for Molina Healthcare. She said some of the health plans were spending more than 100 percent of the funds they received from the state on patient care.

Rep. Matt Hudson (R-Naples), chair of the health care appropriations subcommittee, tried assuring residents the plan will improve patient care and insisted the expansion is not just about saving money.

Rep. Gwendolyn Clarke-Reed, a Deerfield Beach Democrat who voted against the bills, said she’s attended similar meetings over the years and heard the same complaints about the pilot program, but has seen little change.

“I hope, AHCA, that we don’t come back to another hearing and listen to these issues for the third time.”