Medicaid for Kids Under Fire
Medicaid for kids under fire
State lawsuit clears roadblock in bid to create improved care
| Patients aren't the only ones hurting. Hospitals across Florida are bracing for a prospective $932 million cut if proposed changes to the Medicaid formula go through. Lee Memorial Health System, which operates The Children's Hospital of Southwest Florida, stands to lose $23.6 million. The Senate Appropriations Committee last week approved a two-year moratorium on the Medicaid rule change. The measure still needs full House and Senate approval, but Lee Memorial lobbyist Keith Arnold called the appropriations vote "a significant first victory." ALSO FROM NEWS-PRESS.COM MULTIMEDIA  Lawsuit filed against Florida health officials (.pdf) |
Imagine being the parent of a child no doctor or dentist wants to see.
All because you don't have your own insurance, you're too poor to pay the bill yourself, and the government insurance that's supposed to cover your child has irked doctors so badly they won't take your child or any others on the plan.
Roughly half of the 1.2 million Medicaid-eligible children in Florida are going with limited or no medical and dental care, according to a lawsuit filed by the state's pediatric and dental associations.
The case, filed a year ago, was immediately blocked by the state, but a new ruling has allowed it to move forward.
Under federal law, states that take federal money for Medicaid must guarantee that people who enroll for the program have access to medical care.
That's not happening, doctors and parents said.
Medicaid reimburses doctors so poorly that many of them cap the number of patients they'll take. Most dentists have stopped taking Medicaid patients.
Other factors are at play, too, but money tops the list.
Area doctors say reimbursements of all kinds, including those from commercial insurance plans, are declining while their expenses are rising. Medicaid only tightens the vise.
Parents don't really buy the financial excuse — and neither do some doctors and dentists who have managed to build successful practices while accepting Medicaid children.
But enough providers have limited their Medicaid patients to make access to medical and dental care a problem — not just in Lee County but across Florida and much of the United States.
That leaves parents such as Cape Coral mom Randye Klein forced to drive to Sarasota to find a specialist who would treat her daughter's chronic ear infections.
It leaves Kerry Ryan, also of Cape Coral, scouring Southwest Florida for care for her eight adopted children — all of whom are on Medicaid because they came to Ryan through foster care.
"You just want to pay for it yourself, but you can't afford it. There's no way. We're not multimillionaires," Ryan said.
Final recourse
There are 28,709 children in Lee County and 1.2 million children in Florida on Medicaid.
Dr. Louis St. Petery, of Tallahassee, the president of the Florida Pediatric Society, said his group and the Florida Academy of Pediatric Dentistry believed suing the state was the medical community's final recourse.
"We, the pediatricians, have spent the last 20 years trying to fix a lot of these problems," St. Petery said. "Frankly, we haven't gotten their ears."
The state's Agency for Health Care Administration, the body that oversees Florida Medicaid and related children's insurance programs, wouldn't comment because of the pending lawsuit.
Parents are frustrated.
"There's no dentist whatsoever that I can take them to," Ryan said. "Our daughter just had to get her braces off because we couldn't take her anywhere to get her teeth cleaned."
In Maryland last month, a 12-year-old boy died from an infection that started with an abscessed tooth, a common ailment of those without regular dental care.
Medicaid economics
It costs a primary care doctor about $70 to see a patient. The fee covers salaries for the doctor and his staff, utilities, rent and other expenses associated with running a practice, St. Petery said. It does not include profits.
If the patient were a Medicaid child, the doctor could expect to get $32, St. Petery said. If the patient were a Medicare-age senior, however, the doctor would be paid about $58.
"It's one thing to give away my professional services. If I don't get paid for those, well, OK. But my staff expects to get paid," St. Petery said. "Medicaid can't expect people to see these patients and lose money on them."
Dr. Paul Werner, president of the Florida Academy of Pediatric Dentistry, said he doesn't think Medicaid payments to dentists have increased in 22 years. So few Florida dentists will see Medicaid children that he has patients who travel an hour and a half to his Boca Raton practice because he sets aside one day a week for them.
"You can always get care somewhere, but you will not have a medical home," said Dr. John Ritrosky, a Lee County pediatrician who oversees the state's Children's Medical Services for disabled children who are on Medicaid.
"You can always go to the emergency room," he said. "The emergency room will not turn anyone away, but the emergency room is the least desirable place to receive care unless you have a real emergency."
Ritrosky said his practice, Physicians Primary Care, and most other pediatric groups in Lee will work to accommodate Medicaid children. But like several other Lee pediatric practices, Ritrosky said PPC has stopped taking new Medicaid patients.
Finding specialists is even harder.
Ritrosky has one teenage patient who needs psychiatric care, but he can't find a pediatric psychiatrist to treat her.
Other children, those with neurological problems or skin conditions, get shuttled to Tampa or Miami because no local dermatologists or pediatric neurologists will take them, Ritrosky said.
"We all know the roadblocks to access is that the reimbursement rates are too low," Ritrosky said. "You can't go into Publix and say, 'I'm going to pay 35 cents for that half gallon of milk.'"
Pay isn't the only thing limiting the children's care.
St. Petery said Medicaid sometimes switches children from one provider to another.
It does not ensure parents receive annual re-enrollment forms to keep their coverage. And it sets arbitrary rules such as one that limits a medical transportation voucher to one ride a day, even if a child needs to go to multiple places.
Patient nightmares
When Kerry Ryan and her husband, Dave, began adopting children years ago, they braced for financial hardships, but they thought at least their health care would be covered.
Technically, it is.
In reality, the care is nearly impossible to find and keep.
"For years we have been battling with medications. They pay for it. They don't pay for it. They pay for it. They don't pay for it," Ryan said.
Most of the children have chronic conditions such as fetal alcohol syndrome, bipolar disorder, autism and attention deficit hyperactivity disorder.
The children living at home range in age from 11 to 18.
"Dr. Ritrosky will say, this one needs to go to that specialist. Well, that's nice, but who's going to supply the specialist?" Ryan said.
She's had to switch medications when Medicaid alters the list of drugs it will cover.
"They're good kids. They're really good kids, but they have to stay on their medications," Ryan said. "They're doing wonderful, but you can see a reflection in their grades: on medication, off medication."
Klein, whose daughter Stephanie battled chronic ear infections, had to make at least five trips to Sarasota to see an ear, nose and throat specialist. Klein spent at least $100 a trip on bus and taxi fare.
"She had to sit there and suffer because no one takes Staywell," Klein said, referring to the Medicaid HMO plan Stephanie was on at the time. She has since changed plans.
Parents don't know where to direct their anger.
"I didn't know who to be more mad at — the doctors who weren't taking it or Medicaid for not paying the doctors enough," said Kirsten Petruzelli, whose 3-year-old son Aiden Geier suffered from a condition that caused him to stop breathing at night.
"As a parent, it's freaky. Your kid needs medical attention," Petruzelli said.
Aiden needed his tonsils and adenoids removed to treat the condition, but she struggled to find a doctor who would accept her Medicaid plan.
She finally found a doctor in Cape Coral who did the surgery last June.
"It ended up working out," Petruzelli said.
A 'hidden tax'
When uninsured kids don't get medical care, everyone pays.
Doctors and hospitals that take Medicaid patients offset their costs by increasing fees to everyone else.
"It's a hidden tax," said Dr. John Donaldson, a pediatric ears, nose and throat specialist and the chairman of the Lee Memorial Health System Board of Directors. "This is government charity. It's a cost shift for the government. They're taxing you again."
Without a regular doctor and preventive health care, these children end up in area emergency rooms.
A doctor's office visit costs $70 or less; a typical emergency room charge is $150, said Dr. John Iacuone, who heads The Children's Hospital of Southwest Florida and often sees these so-called ER "frequent fliers."
"It's going to come out of somebody's pocket," he said.
Sixty percent of the patients at The Children's Hospital are uninsured, underinsured or on Medicaid, putting the hospital under considerable financial strain, Iacuone said.
Making the problem even worse: The number of children on Medicaid has dropped in recent years because of factors ranging from language barriers to the cumbersome registration process to a lack of case workers who can identify and enroll eligible children, Iacuone said.
Children dropped from Medicaid usually end up with no insurance, and the hospitals can pretty much kiss their fees goodbye.
"That kid we could get reimbursement for — even at a miserable rate — we get no money for," Iacuone said.
posted by Unknown @ Sunday, March 25, 2007
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