Tuesday, July 19, 2011

The State of Florida Medicaid

The Medicaid bill passed by the Republican-dominated Florida legislature and signed by Gov. Rick Scott would allow health care providers to deny access to patients. Medicaid was designed to give health care to people who could not afford to pay for medical expenses. What Scott and other Republicans want is not health care access to the poor, but health care providers getting government money to increase profits.

Scott and Republicans are basing their policy on a failed Medicaid pilot program. Dr. Aaron Elkin, president of the Broward County Medical Association, told the Florida Independent that the pilot program is a failure.

Dr. Aaron Elkin, president of the Broward County Medical Association, tells the Independent all the data available on the Medicaid Reform pilot shows it has failed.

He says doctors and hospitals are not available for patients in the Pilot due to the hurdles imposed under the HMO model. He adds that Scott’s determination to cut the budget will only increase the Pilot’s problems, because there will not be enough doctors, hospitals and health workers to implement the program.

Florida House Democrats Elaine Schwartz, Mia Jones, Mark Pafford and Steve Perman sent a letter to the Center for Medicare and Medicaid Services. They are asking the Obama administration to deny the implementation of the privatized Medicaid program.

"The new legislation builds on a failed managed care platform, expands its scope, introduces additional experimental elements and dramatically accelerates its implementation, but without resolving the outstanding problems and concerns of the current pilot," says the letter signed by Reps. Elaine Schwartz, Mia Jones, Mark Pafford and Steve Perman.

A Georgetown study found that the Duval County and Broward County pilot program that the HMOs did not have a big enough risk pool. This leads HMOs to try to deny coverage. The provider service networks were more successful because they were reimbursed for covering at-risk patients.

Health plans operate in much the same manner. The government pays the plan – for example an HMO – a set fee per person. The fees for those who do not get sick provide the cushion needed to pay the bills of those who do, and provide a profit for the HMO.Further protection is offered by a system of risk adjustment where the per-person payment is adjusted based on the “risk profile” of the client pool. Thus if one plan enrolls a higher share of patients with existing health conditions, it receives a higher average per-per-son payment. Part of the risk is random, since everyone has a chance of needing health services, but the risk adjustment helps since those with existing conditions are more likely to need services.Since the beginning of Medicaid reform, HMOs operating in there form counties have operated “at-risk,” that is, they receive a per-patient fee based on the risk profile of their client pool. It is up to the HMO to ensure that there is enough money to pay claims and turn a profit.PSNs, on the other hand, have not operated at risk to date. They are reimbursed for their actual costs for each patient. (This is the same manner in which the state’s MediPass program previously operated.)In September 2009, however, PSNs will be required to go at risk,operating in the same manner as HMOs.

The Georgetown study found that after the pilot program was instituted, there was a ten percent decline in doctors serving Medicaid patients. The pilot program also lost patients. The short answer is Florida created a public option program with more red tape.

Similar to what was reported in Briefing #2, providers who have remained in Medicaid are seeing fewer Medicaid patients. About 38 percent of physicians surveyed in 2008 reported that they retained half or fewer of their patients. In some cases, physicians dropped plans after bad experiences.One physician in Broward County said his frustration with some plans led to with-drawing from their networks. “I’ve let go of one or two of [the plans] – it is the most difficult experience that you can have. You are coupling low pay-ments with a high threshold [in terms of prior approval] to get care and diagnostic testing. Coupling the worst things you can do!”

Scott and the Florida legislature waived that health care providers had to use 85 percent of Medicaid funding for patient treatment. Republicans did this to insure greater profits for the health care industry. Encouraging the health care industry to inflate their administrative cost is exactly the opposite of what series people have been trying to do in reforming the health care system.

The Georgetown study is under the fold.

Florida Medicaid Pilot Program - Georgetown Report

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