Major changes occurring with little attention By Andrew Leone
Published in the Sun Sentinel
July 31, 2006
Medicaid reform, pursued by Gov. Jeb Bush and approved by the Florida Legislature in special session last December, is here amid no discernible fanfare and the apparent lack of interest on the part of the media.
Touted as a way to control Medicaid spending while providing beneficiaries with a wider array of choices in services, reform entails moving users from Medicaid (the health care safety net of last resource for low-income Americans) to private managed care plans.
In its first year, reform will affect over 130,000 Medicaid recipients in Broward County. By 2011, all 1.2 million Medicaid beneficiaries in Florida may be enrolled in managed care plans.
Although the official start date for reform was July 1, media have taken no notice. In Broward, not even articles announcing the installment of Alan Levine (former secretary of the Agency for Health Care Administration) as the new CEO of the North Broward Hospital District mention his role as major architect of the reform plan.
To advocates who work on behalf of Medicaid beneficiaries, and to many beneficiaries themselves, this silence is cause for concern. Considering the revolutionary nature of Medicaid reform, one would hope that those charged with implementing it are not making preparations for a possible Category 5 storm of Medicare Part D proportions by hoping the public will just look away.
In passing reform, the Florida Legislature wisely mandated not to expand it beyond the "pilot" counties without prior legislative approval, to be based upon an evaluation. A Medicaid Reform Advocates Coalition, comprising Florida CHAIN and other organizations that work on behalf of Medicaid recipients, has put forth four "core issues" that must be considered integral to the evaluation process.
1. Issues related to quality and quantity of "choice counselors" available to consumers: The first 22,000 mandatory enrollees were to be mailed notices of the choices of managed care plans beginning July 24. From that date, they were to have until Aug. 18 to choose one of 16 HMOs and PSNs in Broward to begin enrollment by Sept. 1. Choice counselors, contracted by AHCA and only recently trained and certified, are entrusted with helping beneficiaries make the right choice of plan. There are 10 field choice counselors in Broward and six in Duval County, in addition to 43 more working from a phone center in Tallahassee. The MRAC is very concerned that the ratio of choice counselors to beneficiaries is inadequate, and that they may lack the depth of information needed to give appropriate advice -- which can mean the difference between proper care and the endangerment of life. The recent GAO report giving low marks to a similar program intended to help Medicare Part D patients only heightens this concern.
2. Outreach to hard to reach populations, i.e. the disabled and the homeless: Choice counseling, choice of plans and all the other potential benefits of reform are of little value if those who will be affected are not reached. Beneficiaries will have 30 days to make a choice or the state will make one for them. Among the issues to consider are those related to the availability of a trusted primary care physician in the new plan, rate of co-payments, breadth and scope of services available and accessibility (many Medicaid recipients have to rely on public transportation when they seek health care). A substantial percentage of Medicaid recipients are disabled and need -- or rather, are entitled by law to -- alternative means of communications such as large print, audio and closed-captioning. Many more are homeless and do not retrieve their mail from the agencies that provide them with that service on a regular basis. Still more are unable to comprehend the content of the notices they receive for reasons ranging from mental illness to a low level of education. MRAC is concerned that close attention is paid to the effectiveness of contracted marketing and outreach companies entrusted with reaching the Medicaid consumer market.
3. Managed care caps and how they will affect services: Managed care companies, as businesses, are concerned with profit. For insurance companies, margins of profits are increased when the populations they cover are generally healthy and require little care. But in cases pertaining to HIV/AIDS and blood disorder patients -- both groups affected by reform -- costs of care quickly reach the hundreds of thousands of dollars. Health care for the most vulnerable should not be beholden to a bottom line. MRAC is concerned that coverage caps do not result in coverage gaps for those whose lives depend on consistent care.
4. The re-establishment of the mandated Medical Care Advisory Committee: Years ago, the federal government mandated that AHCA install a Medical Care Advisory Committee, comprising a variety of stakeholders in health care to provide a sounding board on issues related to health care policy. Though mandated, the advisory committee has not met since 2000. A true "place at the table" for consumers and the advocates that protect their interest is essential in the evaluation of Medicaid reform. MRAC believes that the Medical Care Advisory Committee should be revived.
Medicaid reform will ultimately succeed or fail on its own merits. But those who rely on Medicaid for their health care and survival should be afforded the opportunity to participate in the process.
Andrew Leone is state organizer with
Florida CHAIN (Community Health Action Information Network).----------- ------------- --------------
Read response of Christa Calamas hereChrista Calamas is Secretary of the Florida Agency for Health Care Administration in Tallahassee.----------------- ------------------- --------------------
Response of Andrew Leone to Secretary Calamas:August 14, 2006
Secretary Christa Calamas
AHCA
Tallahassee, FL
Dear Secretary Calamas:
Florida CHAIN values a constructive dialogue with AHCA on matters pertaining to health care issues. Consequently, I was happy to read your response to my July 31 Op-ed piece (South Florida Sun-Sentinel, August 7 “Vulnerable Are Being Served”). However, I was also concerned with the tone of your response and some discrepancies between the concerns raised and the statements you attributed to me.
Florida CHAIN and advocates in Broward and Duval are worried about the ratio of Choice Counselors vs. enrollees—although I did not “assert that the state is unable to handle the volume of enrollments into Medicaid reform plans,” as we don’t know that yet. Many advocates have had the opportunity to meet with Choice Counselor supervisors in the pilot counties and with Medicaid Dept. Director Tom Arnold and his District Staff. In general, we have been impressed by their desire to work closely with Community Based Organizations like ours to address these issues of concerns.
Nonetheless, as field Choice Counselors were not hired until mid-June and trained until just before the July 24 rollout, as advocates, we believe that, far from inappropriate or outlandish, it is our responsibility to our constituencies to raise these concerns. We would welcome a response on your part expressing a willingness to look closely at the issues as they develop through implementation and address them appropriately if needed.
I am sorry that the concern raised in regards to caps and the reality that private health care plans are in business to make a profit were reiterated as: “Mr. Leone claimed that HMOs will only offer coverage to healthy populations." Although we don’t know how many Medicaid beneficiaries will be affected by caps in services, this is raised as an issue to avoid “doughnut hole” like mishaps already affecting many Medicare Part D enrollees. We hope that there are better, more effective ways to address these and any other concerns brought to the forefront by consumers and advocates as they arise.
Florida CHAIN believes that Medicaid reform will succeed or fail on its own merits. As an organization dedicated to improving the health and wellbeing of all Floridians, especially the disenfranchised communities, it is our obligation to give voice to the concern of consumers and advocates through the evaluation process that will determine whether Medicaid reform should be expanded statewide.
Florida CHAIN and I look forward to a continued and fruitful collaboration with you in the interest of better serving Florida’s health care needs.
Sincerely,
Andrew Leone
State Organizer
Florida CHAIN
