State seeks to preserve its system for low-income patients

Tora Goings, 19, keeps her daughter Aniyah Haynes, 5 months, upright as Dr. Carola Fleener conducts a checkup at Sarasota Children's Clinic. STAFF PHOTO / RACHEL S. O'HARA  

Tora Goings, 19, keeps her daughter Aniyah Haynes, 5 months, upright as Dr. Carola Fleener conducts a checkup at Sarasota Children's Clinic. STAFF PHOTO / RACHEL S. O'HARA

 

Florida is asking the federal government for permission to extend a five-year-old program that funnels most Medicaid patients into private insurance plans in an ongoing effort to save money.

The public has until Thursday to share feedback with the Florida Agency for Health Care Administration before its proposal is submitted to the Centers for Medicare & Medicaid Services. Federal approval would allow the state to continue outsourcing responsibility for some 3.6 million patients to private contractors for three more years, beyond the program's expiration date of June 2017.

Medicaid uses state and federal funds to provide free health coverage for low-income children and their families, low-income seniors and low-income people with disabilities.

Florida has been rolling out and refining its Medicaid delivery system since 2011, when state lawmakers turned to privatization as a budget-balancing strategy. By 2014, nearly all Medicaid beneficiaries statewide were enrolled in "managed" care plans: Private health insurance plans contract with the state to cover patients who agree to see certain doctors only, and doctors are paid a negotiated rate to serve those patients. The state agency oversees the plans, and pays a flat rate each month to cover the cost of each patient's care.

Overhauling the huge government program was a controversial move in Florida, but the state maintains that since 2011 the per-patient annual cost for Medicaid "has dropped steadily and consistently over the last several years, from $6,564 to $5,878."

Still, the system has its critics. This year a statewide survey of pediatricians — commissioned by a partnership between the Georgetown University Center for Children and Families, the Community Foundation of Sarasota County and the Herald-Tribune — found that access to decent care is a problem for children on Medicaid.

And findings based on a Medicaid Managed Care roundtable at the Children’s Board of Hillsborough County in the summer highlighted problems with enrollment, agency transparency, network adequacy, reimbursement, access to mental health, dental care and other specialty services and lack of care coordination for persons with chronic and complex diseases.

For adults, new federal regulations require plans to cover services that address prevention, diagnosis and treatment of a condition. Florida’s Medicaid program is the only program in the country that does not cover any adult immunizations — despite recommendations made by the Centers for Disease Control.

Transportation to medical services is challenging to rural residents who are forced to travel long distances to fill prescriptions since smaller, local pharmacies are often outside of their plan’s network, according to the findings.

Also, most Medicaid recipients are unaware of their protections in regard to their health plans’ services and are unaware of the complaint hub and how to access it.

The Florida Community Health Action Information Network, or CHAIN, a statewide consumer health advocacy organization, is presenting its findings to AHCA and has created an online form for submitting comments to the state. It can be accessed here.