At the Agency for Health Care Administration’s packed and overflowing public hearing in Largo Wednesday, residents, businesses and local pharmacists raised concerns about Florida’s Medicaid reform — specifically the new statewide managed care plan, which will privatize the program and may potentially create more bureaucracy like Wilson faced.
Gov. Rick Scott signed a bill on June 2 that will transition certain Medicaid recipients to HMOs and other private, managed care providers. The change is designed to lower the cost of Medicaid in an effort to address the state’s $3.6 billion deficit.
Residents worry that red tape will slow the medical process and that managed care plan officers who report to investors will make medical decisions for recipients, putting profits before patients.
Recalling Alisa Wilson’s tragic story, Jacksonville Pastor David Lawson said, “People who want Medicaid managed care for profit reasons don’t have the courage or conviction to kill people, because that’s the only way to save money.”
The overhaul will affect more than 3 million elders, disabled people, families, pregnant women and children in low-income families.
Reform supporters like Chief Medical Officer of United Healthcare Craig Gage said the plan will help provide more care to more people at predictable costs, and it will better coordinate care through a computerized, accessible record-keeping system.
“It’s not about insurance companies, it’s not about elder care attorneys, it’s not about pharmacies or hospital providers," Amerigroup President and CEO Bill McHugh said. "It’s about members and taxpayers who are paying for it.”
However, Al Tower, Director of the Florida Pharmacy Association pointed out that the program has no provision for mom and pop pharmacies to continue to serve Medicaid patients.
Residents expressed additional concerns about the plan’s financial incentive for “dumping” nursing home seniors and the mentally and physically disabled into home-based or community-based care.
Kathleen Regan of the Florida Nurse Practitioner Network insisted that some long-term community-based facilities in managed care HMOs have excellent care, urging AHCA to choose appropriate models that work.
Conversely, elder law attorney Travis Finchum of Clearwater, who served on the boards of many non-profit organizations that focus on advocacy and local services for the disabled and mentally ill, said the new plan is all about cost management through moving people to less expensive environments. He added that no provisions are in place to address the needs that will arise during and after the transition.
“The mentally ill community are receiving most of their services in the prison system and in the jail system,” Finchum said.
Administrator Debra Stewart of Clearwater's Emerald Home Health Care Services said the program’s reimbursement for home health is a lot less that what she would pay the at-home nurses needed to accommodate new patients. Furthermore, the new program will prohibit her from providing charity services for those in need.
Florida has the fourth largest Medicaid population in the country, and more than 60,000 seniors are on a waiting list for elder care and services. Potentially, more will be added to that list when an estimated 35,000 seniors are transitioned out of nursing homes.
Clearwater elder law attorney Charlie Robinson said the new system is unsustainable and that Florida should be a living laboratory for Baby Boomer health care innovation.
“Elders must be excluded from this horrible experiment,” Robinson said, adding that a rise Alzheimer’s and autism diagnoses will likely break the system.
St. Petersburg elder law attorney April Hill said seniors need access to specialists, which some argue will be hindered or halted by the managed-care system. She added that federal law prohibits state Medicaid plans from requiring those who are eligible for Medicaid and Medicare from enrolling in a managed care organization.
However, Michael Garner, President and CEO of the Florida Association of Health Plans, insisted that the current program makes access to a specialist nearly impossible and that the proposed program will eliminate wait lists.
The Florida Community Health Action Information Network has documented the problems of a five-year, five-county managed care pilot project.
Advocacy Director Patrick Cannon said, “The state’s attempt to expand managed care statewide is a huge mistake, and if it is allowed to continue it will harm many people — children, seniors, the disabled — Florida’s most vulnerable residents.”
Cannon urged residents to contact legislators and the federal Centers for Medicaid & Medicare Services in Baltimore about changing the plan.