Medicaid Reform Advocates Coalition Blog

Medicaid Reform Beneficiaries Describe Glitches at Roundtable

2007-08-02T14:02:00.000-04:00

August 1, 2007

Diverse Consumers and Providers Share Gaps, Lapses

On July 25, Florida CHAIN, part of the Medicaid Reform Advocates Coalition (MRAC) conducted the 4th in its series of Medicaid Reform Consumer Roundtables. Recognizing that, a year into the pilot program, issues arising concern not only beneficiaries but Community-Based Organizations that provide services to different constituencies, the roundtable also included a number of such providers. Throughout the evening, participants answered a series of questions ranging from changes in delivery and accessibility of services, to being billed for services, to the Enhanced Benefit component of Reform.

Some of the more disturbing consequences of changes brought about by Medicaid reform have been experienced by individuals who rely on mental health services and the delicate balance of therapy and medication that allows them to function.

Sharon Grad described how her daughter Lori, who suffers from severe mental illness, was bounced from one institution to another as her condition worsened, because the plan she was enrolled in would not pay for services she had previously received. “The police took my daughter to Tamarac Pavilion, where she had gone before and was covered by Medicaid. After one day they discharged her because the Reform plan she is in does not cover her there. She was sent by ambulance to a psychiatric hospital where they kept her for a week and discharged her with medication that caused her to pass out. So we called her primary care physician, who had no availability at that time and suggested we take her to Coral Springs Hospital. Unfortunately, what my daughter needed at the time was a psychiatrist to evaluate her medications. But no psychiatrist under her plan could see her at Coral Springs Hospital, so she was kept under observation for three days, and eventually they sent a psychologist. Talking is not what she needed,” she said.

Another participant, Betty Antoine, who is her mother’s caregiver, described how, after getting a list of doctors her mother could see from a Choice Counselor, she found that none of the providers were taking Medicaid patients in the plan she had chosen, “Except for one that was on vacation, so my mother could not see him for two weeks.”

In discussing access to providers, some participants also addressed the issue of transportation, which, under the terms of Reform, must be provided by the Managed Care Companies at the same level or better than by Medicaid.

For Howard Kaplan, who relies on public transportation, getting the needed bus pass was previously provided by Medicaid “like clockwork, on the 19th of every month.” Now that he is enrolled in a Reform plan, it’s become a monthly nightmare. “First the health insurance company told me to contact the transportation subcontractor who is located in Brevard. They sent me forms that I have to fill out every month and told me to fax them back to them, but both of the fax numbers they gave me are down.” In addition, Kaplan now has to have lab work done at facilities that are much further away than before Reform, and require bus transfers.

For Lori Lotter, who is homeless and relies on very limited income, Medicaid Reform has meant that now she has to co-pay $2 each way to and from her medical appointments using transportation company her HMO provides, which in her situation makes a big difference.

On the question of Enhanced Benefits, the program that allows Medicaid beneficiaries to accrue credits for positive health behaviors that they can cash in for over the counter pharmacy products, the response from participants covered the gamut: some had not heard nor received information about it, some who did and tried to cash their benefits at local pharmacies found that the latter had no idea about the program or what products are covered, and two participants had no trouble cashing in their credits.

Kaplan raised an issue that is common to many Medicaid recipients: not being able to rely on the internet to facilitate navigating through the Reform system. “I went to my local Walgreen’s with my enhanced benefit statement and the tech there told me to contact AHCA to find out what products are available,” said Kaplan. “I called AHCA and they told me to look the list up on line. When I told them (like many beneficiaries) I had no computer and asked them to send me the information on paper they told me they couldn’t because it is 700 pages long.”

Some providers described many additional burdens in getting needed services approved, and often providing services without guarantee of reimbursement form the plan. “If the person you are talking to is suicidal, we will provide the services they need whether their HMO approves them or not,” said Sheryl Hidalgo of Henderson Mental Health Center. In addition, Henderson staff take it upon themselves to arrange for client transportation to and from medical services, often providing transportation without getting plan reimbursement. “Before, Medicaid reimbursed us. Now plans require that severely ill patients make their own transportation arrangements, which is not realistic, so we try to do it for them,” said Hidalgo.

Yvonne Gamble, a nurse at SOS Children’s Village, a foster care services provider, has approximately 70 children in her care. She referred to “the nightmare of keeping up with what plan each child is in,” as these are constantly changing and many children who are not required to be enrolled have been, because of communication glitches between AHCA, DCF and Child-Net, the various agencies required to keep track of health care for foster children.

All Medicaid Reform roundtable participants reported having received bills for different services, ranging from ambulance transport to specialists' visits to being asked to pay for prescription drugs previously covered under Medicaid.

One person who did not attend the roundtable but was interviewed previously was Janet Barnett. A retired nurse familiar with navigating the system, she was recently diagnosed with carcinoma of the liver. Being forced to choose a plan under Reform, she chose the one that included her oncologist over the one that included her primary care physician. As part of her treatment, she was required to undergo a cath-lab (the insertion of a tube through the artery to detect and repair arterial blockages), because of severe heart murmurs. “The one most important thing people with my condition are warned about is to avoid stress,” said Barnett. “You can imagine the stress I felt when I received a bill from the cardiologist for the procedure because the plan wouldn’t pay for it,” she said.

This was right before having to go back in to receive massive chemotherapy directly to the liver to combat the disease.

(Submitted by Andrew Leone, Florida CHAIN)

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Town Hall Meeting Near Tampa Highlights Concerns about Medicaid Reform Expansion

2007-08-02T13:57:00.000-04:00

August 1, 2007

Over a hundred people attended a town hall meeting in Ybor City, near Tampa, to discuss the effects of Medicaid reform on consumers and providers in the pilot counties of Broward and Duval. The program included a presentation by Dr. Jack Hoadley, senior researcher of the Georgetown University Health Policy Institute, on how reform has changed access to prescription medicines for Medicaid beneficiaries (see related story for complete information on the Georgetown report).

Other speakers at the event included Sarah Sullivan, of Jacksonville Area Legal Aid; Lynne Granger Boyden, of Eastside Speech Therapy; and Andrew Leone, of Florida CHAIN. Each discussed issues related to reform including how it has affected consumers and small providers, and the advocacy efforts taking place in the pilot counties to forego the expansion of the program unless and until negative issues affecting consumers and providers are resolved.

Among the attendees were consumers, providers, University of Florida and Office of Program Policy and Government Analysis (OPPAGA) representatives, and State Representatives Ed Homan and Betty Reed. Dr. Homan, an orthopedic surgeon, exhorted those present to become activists against the expansion of Medicaid Reform by writing letters to the media and their representatives and demanding meetings at legislators’ district offices. Medicaid Reform can expand beyond the pilot counties only if the Legislature allows it by a vote expected next year.

The event was co-sponsored by the Tampa Bay Healthcare Collaborative and Florida CHAIN and was organized by Enid Gildar, a Speech Language Pathologist in private practice in Hillsborough County.

(Submitted by Andrew Leone, Florida CHAIN)

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Georgetown Study Exposes Medicaid Reform Prescription Drug Problems

2007-08-02T13:50:00.000-04:00

August 1, 2007

In the third of a series of webcast presentations, Dr. Jack Hoadley, of the Georgetown University Health Policy Institute, reported on a specific set of challenges faced by Medicaid Reform consumers. The report, accompanied by the briefing “Uncertain Access to Needed Drugs: Florida’s Medicaid Reform Creates Challenges for Patients” depicts a system in which most Reform HMO’s take full advantage of their right to limit the drug benefits and, by doing so, often create additional obstacles to health care access for Medicaid consumers.

The study focused on HMO’s rather than Provider Service Networks (PSN’s), Hoadley explained, because “3/4 of Broward's and 2/3 of Duval's reform enrollees are in HMO’s. In addition, PSN’s still operate under the old fee for service model, so they continue to provide medicines according to the state’s formulary,” he said.

Conducted over a period of 3 months earlier this year, the study seems to indicate that Medicaid Reform has had a particularly troubling effect on those who suffer from mental illnesses. “Reform allows plans to make substitutions. In some instances mental health drugs, such as atypical anti-psychotics, are not covered by the plans and switching patients (to other medication available through the plans) causes them to become unstable. Different drugs may not work as well and the consequences of switching are greater,” he said.

The disabled, who often take multiple prescription drugs, are also disproportionately affected by Reform. The pressure on plans to maintain a lid on costs may, over time, create additional barriers to access to medicines.

One of the biggest ongoing problems Medicaid consumers face in trying to determine which plan is best for their needs, is that the Choice Counselors, who are supposed to help them decide, have no access to the plans’ Preferred Drug Lists (PDL’s). This issue, raised by advocates from the earliest days of Reform, prevents consumers from making informed choices at the beginning of the enrollment process. “They instruct callers to contact the plans to get the formularies,” said Hoadley. The problem with this is that most plans provide their formularies online, but many Medicaid consumers have no access to the Internet. “It is challenging to get the information from the plans, difficult to find and use the lists,” Hoadley said.

In response to a participant who asked why Choice Counselors had no access to the plans’ PDLs, Hoadly reiterated the positions taken publicly by Director of Medicaid Tom Arnold and Director of AHCA Dr. Andrew Agwunobi that, “Choice Counselors do not have the necessary training to provide callers with prescription drug information.” Hoadley added, however, that “Counselors who help consumers with choosing Medicare Part D plans do provide (PDL’s), so there is a federal precedent. Why not allow Choice Counselors to just provide lists of drugs available?” he said.

The reports by Georgetown University on the effects of Medicaid Reform in Florida are funded by the Jessie Ball duPont Fund. Visit http://hpi.georgetown.edu/floridamedicaid/ for the full set of reports.

(Submitted by Andrew Leone, Florida CHAIN)

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Nassau County Commissioners Continue Medicaid Reform Delay Effort

2007-08-02T13:48:00.000-04:00

August 1, 2007

In a test of wills reminiscent of David and Goliath, the Nassau County Commissioners declined an invitation by State Rep. Aaron Bean to meet with the Director of the Agency for Health Care Administration (AHCA), Dr. Andrew Agwunobi. According to a number of Commissioners, the meetings to discuss their concerns with expanding Medicaid Reform was to have taken place in Mr. Bean’s office on an individual basis. The invitation comes on the heels of the Commission’s formal request to Gov. Charlie Crist to delay the implementation of Medicaid Reform in Nassau County, where looming property taxes threaten to undermine delivery of basic services to many of the rural county’s Medicaid consumers.

Mr. Bean, representing Fernandina Beach, is a strong proponent of the Medicaid Reform plan that shifts Medicaid services from the state to private Managed Care Organizations.

In response, the commissioners voted to have the County Attorney draft a letter to Dr. Agwunobi inviting him to speak publicly on the issue in commission chambers at any time. According to Commissioner Mike Boyle, Rep. Bean’s office declined on behalf of Dr. Agwunobi. “I find it bizarre that they wouldn’t want to hear our concerns in open forum,” said Mr. Boyle in an exclusive interview with Florida CHAIN . “I mean, wouldn’t it be more efficient to get the whole thing out in the open in 1 hour instead of individually meeting with commissioners half an hour at a time? Our intent is not to be confrontational, but as commissioners we have fiscal obligations and we are concerned that the Governor’s tax relief program doesn’t explain clearly how it will affect county residents who are on Medicaid.”

The Fernandina Beach News Leader, on July 9th reported that, “Commissioners adopted a resolution at (their) regular meeting requesting that Crist give them time to discuss potential pitfalls, namely Medicaid recipients' lack of access to health care in Nassau County.” According to the paper, Mr. Boyle said, “implementation of such a program in a county that currently has no Medicaid providers would be irresponsible.”

The Governor has not issued a formal response to the Commissioners’ request to date, but was quoted recently as cautioning against predicting “doom” related to the Reform program’s effects. “We think this request to meet Dr. Agwunobi may be the Governor’s reply,” Mr. Boyle told CR. “This is a Governor that has made commitment to open government a priority of his administration. The commission chambers are a much better forum to discuss our concerns than individual meetings,” he said.

In refusing the invitations by Mr. Bean’s office to meet with Dr. Agwunobi, the Commissioners may have been mindful of Florida’s Sunshine Law that requires that all the public's business be conducted in the open, including discussions, deliberations and decisions between two or more officials.

(Submitted by Andrew Leone, Florida CHAIN)

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Report: Medicaid standards lacking

2007-07-25T08:32:00.000-04:00

A pilot program in Florida is under scrutiny.

By STEPHANIE GARRY
Published July 25, 2007

The federal government may not have followed the law when it approved Florida's Medicaid reform.

As a result, poor children and pregnant women are paying more for lower-quality health coverage, according to a legal opinion released Tuesday.

Health advocates said the opinion from the U.S. Government Accountability Office is more evidence that the Florida Legislature shouldn't expand the pilot program, which Gov. Jeb Bush spearheaded in 2005 to end Medicaid entitlement and reduce skyrocketing costs.

About 166,000 children, parents and people with disabilities participate in the pilot in Duval and Broward counties.

Andrew Leone of Florida Community Health Action Information Network, said the report reinforces his organization's belief that the reform plan was half-baked.

"Medicaid Reform in Florida was rushed through the Legislature for political reasons, without enough time to review its consequences on the consumers it is supposed to benefit," Leone wrote in an e-mail.

In a 13-page letter about Florida and Vermont's Medicaid programs, the lawyer for the GAO, the investigative arm of Congress, wrote that the Department of Health and Human Services overstepped its legal authority when it allowed Florida to implement the pilot.

Specifically, the report says the program violates standards by providing just a few health benefits while Medicaid recipients are deciding on their health plan and by subsidizing employer-provided health insurance without requiring it to offer top-notch benefits.

The federal government pays 56 cents of every dollar a state spends on Medicaid, so it imposes requirements on the quality of health care provided with the money.

The U.S. health department can waive those rules so that states can experiment with better programs, but the GAO opinion suggests Florida went too far by failing to provide minimum standards.

Joan Alker, a senior researcher for the Health Policy Institute at Georgetown University, said the waiver that allowed the pilot program to go forward was okayed in just eight business days.

The quick approval set a "new world record," Alker said, because the president and then-governor of Florida are brothers.

But the climate won't be so receptive when the pilot is up in 2010, when neither Bush is expected to be in office, Alker said.

"Florida's Legislature should think long and hard about that before expanding the pilots beyond the existing two counties," Alker said.

Stephanie Garry can be reached at 727 892-2374 or sgarry@sptimes.com

[Last modified July 24, 2007, 23:32:34]

2007-06-24T04:31:00.000-04:00

Dear Friends,

We must band together to solve Florida's ever-widening Health Care ills. More specifically, the quality status of Health Care in south Florida is in distinct jeopardy due to the unique geographic and economic make-up of Florida's three (3) most populated counties (i.e., Palm Beach, Broward, Miami-Dade). It is simply unrealistic to expect our state's Health Care delivery systems to magically align in a manner that ensures top-quality, affordable, and accessible Health Care for all Floridians.

With the 2008 election season in full-swing, it is time for caring and compassionate people to band together and elect leadership that will implement curative measures throughout our Health Care arena.

Keeping in mind the millions of lives affected by Medical care and treatment throughout the State of Florida, I pledge to do my level-best on this matter.

Sincerely,

Marion D. Thorpe, Jr., M.D., M.P.H.

www.marionthorpe.com

Palm Beach County faces health care crisis as family practices dwindle

By Patty Pensa
South Florida Sun-Sentinel
Posted June 24 2007

Dr. Jim Byrnes already has more patients than most family practices, yet every week his office is hounded by dozens more in desperate search of a doctor.

Six miles west of Byrnes' Delray Beach office, Dr. Robert Cohen is fast building a practice. The Pittsburgh transplant has attracted 2,000 patients in less than a year.

Both are experiencing the effects of a physician shortage on the brink of collapse. It has touched medical workers from neurosurgeon to nurse, but none so far-reaching as the family doctor, considered the cornerstone of health care. In Palm Beach County, the population continues to grow while the number of family doctors is expected to drop.

"It's a sad fact," said Cohen. "There's a tremendous demand for good-quality doctors."

If nothing changes, patients could be left without a primary care doctor. It's a grim scenario affecting Florida and much of the nation.

The high cost of malpractice insurance and low reimbursements for care are the one-two punch against doctors. But family doctors have specific challenges: Like most doctors, they run businesses with high overhead, but family doctors get paid less for visits compared with specialists. As a result, fewer new doctors are turning to family practice as the number of physicians nearing retirement increases.

"If you can't find them, you're stuck using emergency care or urgent care centers," Byrnes said, "and you're stuck overburdening the whole system."

Family doctors average 2,000-2,500 patients but Byrnes has more than 3,500. His office has to turn away almost everyone who calls.

Byrnes works about 80 hours a week: He starts his day at 6 a.m. with his patients at the hospital, sees patients in his office during the day and finishes with paperwork by 7:30 p.m. On the weekends, he visits patients in nursing homes.

Byrnes, who is 55, expects to retire in 10-15 years. Half of Palm Beach County doctors aged 45-54 plan to stop practicing, reduce their workload or change their practices in the next few years, according to the Palm Beach County Medical Society.

The problem is exacerbated by the high number of older doctors here — 40 percent of the work force compared with a quarter nationwide.

As the county's population grows, the county will need about 375 family doctors in four years, according to the medical society. But with retirements, less than 200 are expected to be practicing.

"This is not an issue the medical community can work on and solve alone," said Tenna Wiles, medical society executive director. "It must be a community-wide effort."

Such challenges are occurring at a national level. About 100,000 family physicians practice in the United States. In less than 15 years, about 140,000 will be needed.

The group launched its "Future of Medicine" project last week to involve business, community and nonprofit groups in addressing the shortage. Earlier this year, the medical society's physician census for the first time revealed how drastic shortages are in some specialties.

About 300 family doctors work in Palm Beach County, about 40 fewer than what is needed, the study said.

The shortage, though, could be worse than statistics show. The study did not account for the growing number of doctors who abandoned their traditional practice for "concierge medicine," charging patients about $1,500 annually for more personalized medical care. Their offices have a smaller patient load, Wiles said.

Family physicians are primary care doctors who treat patients of all ages. Pediatricians and internists, who treat only adults, are also primary care doctors. They are expected to reach shortage levels in Palm Beach County when doctors retire in about four years.

"It's extremely expensive to run a practice," Cohen said. "On the other side, you can build a practice quickly because there is such need."

Family doctors in Florida make, on average, $150,000. Surgeons earn about $165,000 and obstetricians/gynecologists bring home about $180,000, according to the U.S. Department of Labor.

"It's very difficult to make any money in primary care unless you're seeing lots of patients," said Dr. Mark Multach, of the University of Miami. "And then, you're not doing your job well."

About 60 percent of Cohen's income goes to overhead such as paying his staff and for equipment. Cohen, though, has augmented his practice to offer blood tests and bone-density scans. He's looking to buy a sonogram machine.

Adding services, which often come with higher reimbursements, can help supplement a doctor's income, Multach said. Insurance and Medicare reimbursements have fallen in the past decade, leading doctors to squeeze in more patients per hour.

A typical office visit will bring a doctor about $30-45. In comparison, reading a stress test nets hundreds of dollars and takes less time, Multach said.

Florida's shortages are most severe in central and northern counties, though virtually all of the state has some degree of a doctor shortage, according to HealthLandscape, which maps data from American Medical Association and the U.S. census.

At the same time, fewer medical students are turning to family practice. A decade ago, it was about 16 percent of students. Today, it's about half that, according to the American Academy of Family Physicians.

Meanwhile, the demand for family doctors is expected to rise as more Americans confront chronic conditions such as high blood pressure and diabetes.

"In 15 years, when we need them more, the primary care physician won't be here," Multach said. "I'm pretty confident of that. Certainly, the system could change. There's been a lot of talk but there's been no movement."

Patty Pensa can be reached at ppensa@sun-sentinel.com or 561-243-6609.

2007-06-13T13:13:00.000-04:00

With disappointment, and continuing determination to help Floridians gain access to quality Health Care, I share the following findings of the Commonwealth Fund. The entire state-by-state rankings can be found at http://www.commonwealthfund.org/statescorecard.

Sincerely,

Dr. Marion D. Thorpe, Jr.

Florida Health Care ranks low

The high number of uninsured residents has been leading to poor-quality health care in Florida, a study reports.

Miami Herald, Herald.com
Posted on Wednesday, June, 13, 2007
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com

State rankings

Here's how the states ranked in a major study of healthcare access, cost, quality and efficiency.

1.Hawaii

2.Iowa

3.(tie) New Hampshire

3.(tie) Vermont

5.Maine

6.Rhode Island

7.Connecticut

8.Massachusetts

9.Wisconsin

10.South Dakota

43.Florida

SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007

With many people lacking access to care and others facing an abysmally low-quality system, Florida ranks No. 43 in the nation in the first state-by-state scorecard of healthcare-system performance.

The survey, being officially released today by the Washington-based Commonwealth Fund, shows that Florida ranks 40th in access to care, 45th in quality and 39th in equity of care. The state does much better in ''avoidable hospital use and costs,'' ranking 26th.

Hawaii ranked first overall, followed by Iowa and New Hampshire. Tied for last were Oklahoma and Mississippi.

''Access is highly correlated with quality,'' said Commonwealth President Karen Davis in a conference call with reporters on Tuesday. Her nonprofit organization specializes in health and social policy issues.

Access generally starts with insurance, which in turn leads to having a regular doctor who can do annual checkups and regular preventive care, stopping problems before they lead to expensive trips to the emergency room.

''Four of the five leading states in the access dimension -- Massachusetts, Iowa, Rhode Island and Maine -- also rank among the top five states in terms of quality,'' the 74-page report stated.

Among the 50 states and the District of Columbia, Florida ranks 50th in coverage, with 26.9 percent of adults under 65 uninsured. Only Texas does worse in the percent of uninsured, and it ranks 46th in quality, a measure that includes such criteria as giving hospitalized patients the necessary treatments and antibiotics.

Joel C. Cantor, a Rutgers University researcher who conducted the survey, said he thought the link between insurance and quality was that insurance brought money into the healthcare system, whereas ``a lack of coverage and high number of uninsured leads to financial distress, less money for information technology as one example.''

INEQUALITIES

Lack of coverage also can lead to inequities, measuring how the poor and minorities do in getting needed care. Florida ranked in the lower half in terms of racial/ethnic equity, according to the study, and in the lower quarter in terms of income equity.

The state did considerably better in avoidable hospital use and costs, which measures such things as Medicare patients being readmitted within 30 days of being discharged and children who had to be admitted because of asthma problems.

The Commonwealth study did not break down areas within states. Separate studies by Dartmouth researchers have found that South Florida hospital costs for Medicare patients are among the very highest in the nation.

Florida also did well in another Commonwealth measure, called Healthy Lives, in which it ranked 25th.

That measure includes infant mortality, percentages of adults who have to limit activities, and deaths from breast cancer and colorectal cancer -- diseases generally considered to be treatable if detected early.

Another state-by-state survey, released by a federal agency on Monday, confirmed the Commonwealth data.

OTHER DATA

The State Snapshots, produced by the Agency for Healthcare Research and Quality, showed that in 129 quality measures, Florida ranked in the lower 25 percent of states.

Confirming the Commonwealth data, the agency said Florida did well by having low rates of death by colorectal and breast cancers. But it ranked 49th in patient satisfaction with Medicare, 48th in diabetic adults given flu shots and 46th in percentage of patients saying they can always get an appointment for care.

The Commonwealth researchers noted there was much room for improvement.

''If all states could approach the low levels of mortality from conditions amenable to care achieved by the top state, nearly 90,000 fewer deaths before the age of 75 would occur annually,'' the report said.

While some political observers believe healthcare reform may be tackled first by some states, Commonwealth President Davis said, ''federal action is essential,'' because lower-income states, particularly in the South, don't have the funds to help the uninsured.

''Moving to extend affordable health insurance to all is critical,'' Davis said.

The U.S. Health Care Front Line: Politics, Reform, and "Sicko"

2007-06-05T18:29:00.001-04:00

The following story from the BBC depicts the dire straits of Health Care delivery throughout the United States. Florida has the potential opportunity to lead the charge for proper development and implementation of Health Care reform measures that will benefit all Patients. I pledge to do my part to make certain that our State and Nation provide top-quality, affordable, and accessible Health Care in a timely and effective manner.

Sincerely,

Dr. Marion D. Thorpe, Jr.

U.S. mulls over Health Care Reform

By Justin Webb
BBC News, Houston
Last Updated: Friday, 25 May 2007, 10:31 GMT 11:31 UK

Devante Johnson died of cancer

"If a politician declares that the United States has the best health care system in the world today, he or she looks clueless rather than patriotic or authoritative."

So says Dr Ezekiel Emanuel, an ethicist at the US National Institutes of Health.

The US health system is in a state of crisis and serious politicians, including several presidential candidates, say the time has come to reform it along the lines of the European or Canadian model.

There is an advertisement running in the US that asks people to put pressure on the politicians to arrange health insurance coverage for every child.

To the rest of us living in the wealthy West it seems mighty odd to put it mildly that such an advertisement would be necessary, that the idea of "getting every child covered" could be remotely controversial.

Fewer safety nets

But the US healthcare system is unique. The US spends hugely more per person than any other advanced nation - but also has fewer safety nets for those on low incomes.

That does not mean that children here have no health care; a child or, for that matter, an adult who is ill and goes to hospital must be treated - stabilised is the word they use - before money is discussed.

But money will then be discussed and without any money treatment can be poor.

I visited the Scott family in Texas. Texas has the worst insurance record of any state, with about a quarter of the population without cover.

Tamika and her two young sons Derek and Demarcus live on the outer suburbs of Houston - a land of multi-lane highways and tatty shopping malls, a place where ends do not always meet.

This is a home that pays its bills - just.

No cover

Above the fireplace there is a picture of a 14-year-old boy - a third brother who is not here. Devante was his name.

Two months ago Devante Johnson died of kidney cancer. His mum had been diligent in getting him care and dealing with the mountain of paperwork involved in paying the bills or getting someone to pay them - insurers, the state, charities.

But a bureaucratic error last year led to the money running out for four months - so a 14-year-old cancer patient had no coverage, no treatment, expect experimental drugs provided for free.

He lost weight and was in added pain his mother says.

Eventually the coverage and the treatment were restarted, but Devante died.

His mother says he would still be alive if she had had the money to pay.

No welfare state

Ana Malinow is a paediatrician at a Texas public hospital and campaigns for this system to change.

Texans are good people she says, they are not cruel and they do not expect children to suffer for lack of cash.

They are just ignorant about the system and ignorant about potential solutions.

It is interesting that even left-wing Americans generally reject the knee-jerk European view of their nation and its affairs: that it is brutal and unforgiving and that this approach is part of "the American way".

There are unquestionably some Europeans who will regard the move towards fairer health care in the US as a sign that America is coming to its senses and might be "more European" in the future - that its love affair with the free market is waning.

As a columnist in the Guardian newspaper put it recently, "is it possible that the era of neo-liberal certainty is waning?"

The answer, in American healthcare, is perhaps.

But in a manner that does not turn the US into a welfare state.

Jonathan Rauch is an academic at the Brookings Institution, a centre-left think tank.

Film attacks system

He says the US system is a bureaucratic mess, but the aims of US doctors and the US public are, he claims, not dissimilar to those of European doctors and publics: that healthcare should be available at high quality to the largest number of people.

Michael Moore is having his say at the moment with his latest film "Sicko" in which he attacks the US system and praises Cuba.

The danger is that Americans see the film and convince themselves that this is just one more over-stated case.

In particular they will wonder whether alternative systems - Cuba and the UK - are really as wonderful as Moore suggests.

But it would be a pity if the debate became mired in a fight over Michael Moore's film-making techniques.

The need for reform is real and Tamika Scott does not need to go to the cinema to learn how unfair the current setup is.

In a world centre of cancer care - Houston - no money could be found for four months last year to treat her son. That is sick.

Crist vetoes HMO increase bill and landlords bill

2007-05-25T00:26:00.000-04:00

http://miamiherald.typepad.com/nakedpolitics/2007/05/crist_vetoes_hm.html

Gov. Charlie Crist late tonight announced that he has vetoed four bills, including a controversial measure that gave a rate increase to Medicaid HMOs and repealed a state law that mandated how much Medicaid plans must spend on providing mental health services to Medicaid patients.

Crist also vetoed a bill dealing with cosmetology, a bill that changes how much landlords can charge tenants who break leases, and a measure that would have raised boat vessel registration fees $2 in order to pay for derelict vessel removal.

The bill dealing with Medicaid HMOs, SB 1116, was one of the so-called conforming bills that accompanied the $71.5 billion budget that Crist signed into law today. But this bill was changed behind closed doors in the waning hours of the session to give Medicaid HMOs a $5 million rate increase starting in January. Crist also faulted the bill for ending a current requirement that Medicaid health plans provide at least 80 percent of money they receive for mental health care on direct services to patients.

"Even more disturbing is that many of these provider driven provisions were not discussed in an open forum,'' Crist wrote in his veto message.

Crist, who still rents an apartment in St. Petersburg, said he vetoed the bill dealing with landlords because the "impact" on those who can least afford it would be too great. The bill, HB 1277, would have allowed landlords to charge additional fees to tenants who want to break their leases early.

To read the veto message on the Medicaid bill: Download VETOSB1116.pdf

Posted by Gary Fineout at 09:43 PM on May 24, 2007 in Charlie Crist | Permalink

Dear Drs. Palamara and Ronik

2007-05-23T11:54:00.001-04:00

On behalf of the Medicaid Reform Advocates Coalition, I extend the following "Thank You" to each of you as follows:

Dr. Palamara,

Thank you for finding time in your busy schedule to share your thoughts and expertise with those of us who read the Florida Medicaid Reform blog. We must remain diligent and proactive in our collective effort to protect Florida’s most vulnerable Patients.

Sincerely,

Dr. Marion D. Thorpe, Jr.

Dr. Ronik,

Thank you for your eloquent description of the problems facing our Mental Health Patients and our Medicaid Patients. Hopefully, the exposure gained via your Sun-Sentinel article will lead to improved quality of care and treatment accessibility for south Florida’s Patient population.

Sincerely,

Dr. Marion D. Thorpe, Jr.

The Medicaid Reform Disaster

2007-05-22T11:24:00.000-04:00

By Arthur E. Palamara, MD
May 18, 2007

In 2005, Florida embarked upon a grand new experiment: placing all Medicaid recipients into HMOs or a similar contrivance called Provider Service Networks. The results may save the state treasury considerable money, but the impact on patients has been less well received, at times catastrophic. The impact on doctors has been equally disastrous. Already reimbursed far below customary rates, many doctors may no longer participate. Bureaucratic hurdles placed by HMOs make it increasingly difficult for physicians to provide care. A survey suggests that it will not be long before docs just opt out.

Before reform, about 95% of Florida doctors - roughly 33,000 - participated in Medicaid. But only 13,000 of these provided any substantial amount of care. Now a survey conducted by Georgetown University indicates that more doctors are dropping out of Medicaid and those that remain are seeing fewer patients. Most doctors stay in the system only out of loyalty to their patients with whom they’ve enjoyed an established relationship. Feeling overwhelmed by the harrowing challenges of just complying with arcane regulations and realizing that reimbursements are inadequate, many doctors are simply quitting. This is especially true among specialists where fully 2/3 plan to resign unless things improve. And there is little likelihood that things will get better since payment to doctors is down while paperwork is up. Not a reassuring combination.

In the pediatric community, pediatricians are finding it increasingly difficult to provide care, especially for 600 children with special needs. Previously, physicians had to deal with the requirements of only one system. Now each HMO has its own indigenous, time-consuming authorization procedure that forces doctors to comply. Often, these “authorizations” are complex and repetitive. The task is particularly burdensome to small offices that lack the staff to fulfill dogmatic regulations. This challenge is even worse for doctors who treat children with HIV since many medications are not part of the HMO’s formulary.

Pregnant women fare no better. Those tough obstetricians who have accepted the challenge of working within the new system do so only because they acknowledge a “social responsibility”. As such, many established Medicaid providers are flooded with new, expectant mothers seeking care. Because of financial constraints, they are finding it necessary to turn away new Medicaid patients.

Even if an obstetrician accepts lower compensation, the additional headache of dealing with 14 separate entities – each with its own bizarre rules – makes doctors disinclined to participate. Where once it was easy to write a prescription for a uterine ultrasound and send a patient to the nearest hospital, now the physicians’ staff must cast about seeking a specific facility that services that HMO. Gone are the days when a doctor just provided care. The doctor has become an uncompensated agent for the HMO.

More frustrating still, some expectant mothers arrived at the doctor’s office unaware of the change because more than a few patients were randomly assigned to HMOs without the patient’s knowledge. As a result of bureaucratic snafus, some expectant mothers were forced to switch plans a mere 2 weeks before delivery!

These Medicaid changes have diminished the number of specialists available to treat complex problems. Hypertensive specialists who treat pregnancy induced high blood pressure – a very demanding problem replete with legal overtones – are few and far between. Unassisted, Ob-gyn doctors are left to deal with the problem as best they can.

Psychiatric patients comprise another very vulnerable population. Emotionally unprepared for the changes wrought by Medicaid Reform, this population already lacked insight needed to make difficult life-decisions. While the law provided choice counselors to help patients select their best option, most choice counselors were under-trained and lacked critical knowledge especially in the area of psychotropic medications. Often taking years to strike an effective balance, stabilizing medications are vitally important to psychiatric patients. Choice Counselors had wrong or insufficient information when answering detailed medication questions. Many patients are now suffering the consequences. The impact on the physician is even more troubling. When the doctor writes a prescription, the doctor does not know if it is going to be filled correctly. This frustration has caused many doctors to opt out of the system.

While doctors are being paid less, the 14 HMOs and Networks are being paid more. Prior to reform, HMO profit was a staggering 18.6%. Despite this, the Florida legislature is planning an 11.7% increase in payments to HMOs. The securities firm CIBC World Markets and Goldman-Sachs reported that WellCare – a major Florida Medicaid HMO – has been shifting money to the Cayman Islands in the form of reinsurance premiums. Goldman-Sachs spokesman Carl McDonald stated that "Florida appears to be overpaying its Medicaid plans, and it would seem to be only a matter of time before the state figures this out." They're making tons of money," said Oliver Marti, a partner and portfolio manager at CCI, a Stamford, Conn., investment firm. "How does the government allow that?" (April 11, 2007, Tampa Tribune.) How indeed!

Florida’s stated objective was to improve both access and care while saving money. Medicaid Reform seems to be accomplishing little except enriching privately held HMOs. There is little evidence to suggest that this reform should be expanded beyond Broward and Duval Counties.

Patients want a trusted provider and physicians want to provide care free from corporate hassle. Medicaid reform seems to have alienated both those who serve and those who are served. With projected shortages of doctors estimated to be 50% within the next 10 years, it remains to be seen where Medicaid patients will receive their care. Probably from emergency rooms - which will place an even greater burden on local property taxes.

Dr. Arthur Palamara is a vascular surgeon in private practice in Broward County. In 2000 and 2001 he served as the Florida Medical Association representative on the Florida Commission on Excellence, which spearheaded many of the improvements in medical care quality that are just now emerging. He served on the Florida Patient Safety Corporation's Near Miss Task Force, and currently serves on the Corporation's Patient Advocacy Committee. Dr. Palamara is former FMA Vice President, serves on the Association's Council on Legislation.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Treatment worth time, money and action

2007-05-22T11:20:00.000-04:00

By Dr. Steven Ronik
Posted on the South Florida Sun-Sentinel, May 21 2007

America is still reeling from the tragedy at Virginia Tech. As we move forward, the natural reaction has been to find fault. We search for the "answer" -- the evidence of what went wrong. While there are undoubtedly many factors that might have changed the outcome of April 16, there is an underlying issue that can't be ignored. While we know that people with mental illnesses are no more violent than the general population, some stark realities are before us to consider.

Mental illness affects almost 60 million Americans. That's an estimated one in every four adults and one in five children. Mental illness is more common than cancer, diabetes or heart disease, making it the leading cause of disability in the United States.

As Americans, we have become so frightened by mental illness, or the stigma associated with it, that we do a fairly good job at ignoring it. Unfortunately, so has our government.

Despite advances in medicine and therapy that make it possible to treat and prevent lifelong disability from mental illness with increasingly greater success, the health systems that do so are dramatically underfunded at all levels. Even Medicare discriminates against mental health treatment, as do private health insurance companies. Almost 90 percent of private health plans place limits on mental health care that they don't place on medical/surgical care.

In Florida, unfortunately, the problem of underfunding is exponentially worse. We rank 48 out of 50 states in per capita public mental health funding -- and whether you are rich or poor, serious mental illness can strike, and comprehensive services are only offered through the publicly-funded system.

To add fuel to the fire, Broward has been chosen as one of two counties to participate in Medicaid reform, which for all intents and purposes is simply a shift to Medicaid managed care. It means that, overwhelmingly, care is authorized by for-profit HMOs.

In fact, in this recent legislative session, the one protection consumers had in this area (which provided that HMOs spend at least 80 percent of their capitation rate on direct service) has been removed. Medicaid reform is intended to be "revenue neutral" but it would be wise to "follow the money."

Clearly less money is going to providers of service, meaning less service is available to our citizens in an already dramatically underfunded county and state.

The cost of all of this is horrific. Senseless tragedies. Wasted lives. Broken families. Increased crime. Lost productivity. Not to mention, losing our most basic and fundamental obligation -- to help those most vulnerable.

Mental illness didn't "cause" the tragedy in Blacksburg. But, it is an example of how our nation's funding priorities did not allow for a comprehensive system of early intervention, assessment, monitoring, and treatment. Many states, and especially Florida, have become a "fail first" system.

In other words, due to incredibly minimal resources, funding priorities are directed to those who have been most impaired and disabled -- creating a system that is too focused on inpatient care and emergencies.

There are solutions. Treatment works. There's no mystery anymore in helping people recover from even the most severe mental illnesses. Early intervention goes a long way in preventing further complications from what can be easily treated more minor mental illnesses. But the problem is of such magnitude that it will take a dramatic shift in our thinking and government action, recognizing the prevalence of mental illness and recognizing that treatment is indeed worth our time -- and our money

The author is chief executive officer at Henderson Mental Health Center.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Medicaid in the 21st Century

2007-05-15T09:34:00.000-04:00

Over 40 years ago, Medicaid was designed with the intention of providing a Safety Net for America's most vulnerable Patients. Prior to its inception, all too many of our citizens were subjected to sub-par and/or non-existent Health Care services based on their respective inability to pay. Though racial segregation played a significant role in determining proper and timely access to care, economic segregation cut across all racial and ethnic lines in determining who did and did not benefit from the overall Health Care gains of our Nation.

Through the years, Medicaid has been increasingly hampered by the ever-rising costs of Health Care, and by detractors who have voiced complaints indicating that Medicaid's Safety Net has become the proverbial "Hammock at the spa." For those who support the Safety Net status of Medicaid and for those who complain about the Hammock status of Medicaid, one thing is for certain:
As a society we are failing miserably in our effort to provide sound, accessible, and affordable Health Care for all Americans.

The debate rages on as to whether Health Care is a Right or Benefit for those who live and work in the United States. Regardless of the ultimate outcome of this debate, Health Care for all will forever remain "The right thing to do" within a caring and compassionate society.

For your review, the following article details the fact that Florida has yet to pave the road to proper Medicaid Reform implementation.

Sincerely,

Dr. Marion D. Thorpe, Jr.

Documented denial

New law is causing problems for legal U.S. residents trying to obtain Medicaid, study shows

By Liz Freeman

naplesnews.com

Monday, May 14, 2007

A controversial law that took effect last year requiring low-income U.S. citizens to prove their citizenship in order to obtain or renew Medicaid benefits is causing havoc among some individuals who are legally entitled to receive the government insurance, according to a study.

The first analysis of the impact of the citizenship documentation rule, signed into law by President Bush and which took effect July 1, involved randomly surveying 300 federally funded health centers around the country about Medicaid enrollment and citizenship proof.

The researchers at George Washington University in Washington, D.C., found that 90 percent of the health centers reported Medicaid enrollment difficulties for patients of all ages because of the citizenship documentation rule. The research was conducted by the university’s School of Public Health and Health Services and the findings were released last week.

More than 43 percent of the health centers said their patients faced a longer enrollment time, lacked the proper documentation to prove citizenship or had to pay to obtain the required documents, the researchers found.

The consequence is that nearly half of them saw a disruption in their ability to get specialty medical care.

Apart from the university research, the Florida Department of Children and Families reports that an average of 400 Medicaid applicants are being denied every month because of the inability to prove citizenship, said Al Zimmerman, DCF spokesman in Tallahassee.

What has not been tracked is how many of the denied applicants return with the citizenship proof and become eligible, he said. The belief is that the bulk are U.S. citizens.

“Nearly all of the people denied are citizens who are unable to come up with a birth certificate or passport,” he said.

From another perspective, the researchers found that the health centers had to beef up staff time to help existing Medicaid patients get re-certified for coverage and to help new patients navigate the more complex Medicaid enrollment system now that proof of citizenship is required.

Proof involves presenting original or copies of a birth certificate, passport, certificate of citizenship or naturalization.

Federal law has always required that Medicaid beneficiaries be U.S. citizens but 47 states allowed individuals to attest to their citizenship in writing. The new citizen documentation rule was put forth to preserve Medicaid budgets, a mix of federal and state dollars, to low-income U.S. citizens and to halt cuts to services.

Several patient advocacy organizations, hospitals and health clinics countered that few illegal aliens were fraudulently claiming citizenship to get Medicaid benefits before the documentation requirement, whether out of fear of deportation or because they knew they can go to a hospital emergency room and get treated regardless of citizenship status. A separate federal law sets forth that emergency rooms must treat and stabilize anyone regardless of ability to pay.

The researchers estimate that the immediate impact of the documentation requirement is it will eliminate Medicaid coverage for as much as 6.7 percent of pediatric and adult Medicaid eligible patients. That translates into as many as 319,500 legal citizens.

Southwest Florida health centers are experiencing different outcomes as a result of the citizen proof rule.

Collier Health Services Inc., CHSI, in Collier County has seen declines in its Medicaid population for both adults and children. On the other hand, Family Health Centers in Lee, Charlotte and western Hendry counties has not.

“Our numbers of patients in total between 2005 and 2006 was pretty flat, it went up a fraction, but our Medicaid percentage for children under (the age of) 19 decreased by 2 percent and for Medicaid adults it decreased by 11 percent,” said Steve Weinman, vice president of CHSI, which has 11 programs and clinics predominantly serving the poor. “Eleven percent is a lot.”

Number-wise, the number of adult Medicaid patients dropped from 1,423 individuals in 2005 to 1,273 individuals in 2006, he said.

“This is a group of people who are not good at managing paperwork, you have to keep in mind,” Weinman said, adding that CHSI has put considerable effort in staff time to help patients who qualify for Medicaid to get enrolled. “(Enrollment) went down this amount even with all the work we did.”

Weinman can’t say absolutely that the citizenship proof rule is to blame but he suspects it is the cause.

“The same thing is being reported all over,” he said. “I’ve heard this from around the state at health centers.”

He questions why the citizenship proof law was enacted at all because few illegal aliens were fraudulently attempting to get Medicaid coverage in the first place.

“The number of illegal people managing to get on Medicaid is pretty minuscule,” he said. “That just wasn’t happening.”

The Family Health Centers, on the other hand, is seeing an increase in its Medicaid population against its total patient base, which went from 31 percent in 2005 to 32 percent last year said Bob Johns, spokesman for the nonprofit organization.

Based on the statistics, the citizenship proof rule appears not to be an issue, he said.

“It may be an anomaly for us,” he said.

The increase in the Medicaid population is a function of population growth, a high concentration of uninsured patients and a concerted effort on their part to increase its pediatric program, he said. Children born in the U.S. are citizens and would be issued birth certificates and so their wouldn’t be an issue with proof, he said.

Hospitals in the region report that the new rule is not causing hardships to the extent anticipated.

There have been cases where Medicaid applicants are being denied coverage for lack of the citizenship proof or other documentation but the Lee Memorial Health System isn’t tracking the citizenship proof issue separately, said Billie Jo DeBolt, director for business services.

“We have had an impact,” she said. “As of yet it has not been as significant as I first thought it would be. That may be just a matter of time.”

The reason for that is many Medicaid beneficiaries haven’t faced recertification yet, so they haven’t been subject yet to the documentation requirement, she said.

“I don’t think we have seen the full impact yet,” DeBolt said.

The NCH Healthcare System in Collier likewise has not seen the problems that they expected, said Debbie Curry, NCH spokeswoman.

“The change requiring patients to prove their citizenship in order to qualify for Medicaid has apparently caused some delays but not to the extent originally anticipated,” she said.

Report on Georgetown University Study of Medicaid Reform

2007-05-10T19:04:00.000-04:00

Daily Health Policy Report

Medicaid | Florida Medicaid Reform Pilot Program 'Appears To Be Reducing' Number of Participating Physicians, Study Finds
[May 09, 2007]
A Medicaid pilot program in two Florida counties "appears to be reducing" the number of physicians who accept beneficiaries there, according to a study released on Tuesday by the Georgetown University Health Policy Institute, the Miami Herald reports (Dorschner, Miami Herald, 5/9). Former Florida Gov. Jeb Bush (R) in December 2005 signed into law legislation that created a pilot program to shift some of the state's Medicaid beneficiaries to managed care plans and cap spending growth on the program at 8% for the next five years. Under the new system, the state pays HMOs higher rates for treating sicker beneficiaries than for treating healthy beneficiaries. The plan began July 1 in Duval and Broward counties (Kaiser Daily Health Policy Report, 1/31/06).

Of 186 doctors in the two counties who responded to a Georgetown survey, more than 25% who had participated in the Medicaid program before the new plan was implemented said that they no longer would participate. Fifty-one percent of doctors said that the new program's restrictions and requirements made it more difficult to provide medically necessary services to children, according to the study (Miami Herald, 5/9).

Two-thirds of physicians dropping out of the program are specialists, the study found. In addition, nearly 40% of doctors who accept Medicaid beneficiaries have continued treating half or fewer of their patients since the program changed. A significant number of physicians also said that under the new system, paperwork has increased and reimbursement for services has declined or stayed the same, CQ HealthBeat reports (Adams, CQ HealthBeat, 5/8).

Researchers noted that only 8% of doctors responded to the survey, so the findings "should not be considered generalizable to the entire membership of these organizations." Meanwhile, four focus groups each comprising about 10 beneficiaries led the researchers to conclude that fewer than 50% of beneficiaries had spoken to "choice counselors" intended to help them understand their health care options (Miami Herald, 5/9).

Reaction
Joan Alker, lead investigator of the study and a senior researcher at Georgetown, said, "There are a lot of warning signs ... with respect to ... some of the experiences beneficiaries are having, and there's concern about providers leaving the program, which could very significantly affect access to needed care." She added, "The study raises a lot of really important questions that need to be ... addressed before the pilots continue any further."

Florida Agency for Health Care Administration officials in a statement said, "As with all studies based on focus groups and surveys, the information is a snapshot of a specific audience at a specific time. We do not agree with all the findings and have asked the university for their data so we can better understand their analysis and conclusions" (Karkaria, Florida Times-Union, 5/9). A CMS spokesperson said that the agency needed more time to review the study (CQ HealthBeat, 5/8).

The study is available online.

Medicaid Reform Consumer Finds Obstacles on Way to Care

2007-05-10T19:00:00.000-04:00

First published on CHAIN Reaction, May 1, 2007

David Reid had just made the jump from the banking industry to the one he really loved, music, when he suffered a brain aneurism in Brooklyn 25 years ago. When he arrived at the emergency room at Kings County Hospital, the attending physician took a look at him and, mistaking his stroke for drunkenness, told him to “sober up” and sent him home. Whatever damage might have been averted by early intervention became permanent with the addition of ensuing complications.

The experience impressed upon Reid the importance of a trusting relationship between patient and doctor. When he moved to Florida, Reid began building that relationship with the scores of physicians he needed to give him the care necessary to lead a decent life. In 1998, for example, he needed three operations to remove some clotting. More recently, he needed to be operated on for appendicitis.

“Under Medipass, it was all covered without problems,” he says in a slightly slurred, carefully cadenced speech. “Until last June I was able to see all the specialists I needed and had gotten to know over the years.” Then, last September, Reid received two Medicaid Reform enrollment packets within the space of 3 weeks. Concerned by the instruction bidding him to choose a plan or have one chosen for him by the State, Reid spoke first to his long time Primary Care Physician who advised him to pick Staywell because he was a provider under the plan. In addition, Reid was “sold” on the additional perks described in the enrollment materials, including the over-the-counter benefits it lists.

“Last December I received a letter from AHCA (the Agency for Health Care Administration) telling me about points I had received to redeem products at the pharmacy,” he recalls. “When I went to the pharmacy with the letter, I was told I needed to contact Staywell to redeem the products. I called Staywell, and I was asked to provide a list of what I wanted. I gave it to them. It’s the end of April and I still haven’t received anything.”

Reid couldn’t recall whether the list of products pertained to the Enhanced Benefit Component of Medicaid Reform or the one provided by Staywell. (The confusion between the two types of benefits has been documented on various occasion in Medicaid Reform Consumer roundtables conducted by Florida CHAIN and MRAC, the Medicaid Reform Advocates Coalition).

Not getting the over-the-counter products perks is annoying but the least of Reid’s problems. Under Medipass, his doctor had prescribed Prevacid to manage another one of the “legacies of my stroke, “as he calls them. Staywell does not cover Prevacid nor his second choice option, and the medicine they do cover causes unwanted side effects.

In addition, once signed up in the plan, Reid realized that his neurologist was not a member. His general internist was listed in the plan directory but had since dropped out, as had his long-time eye doctor. When he called Staywell to tell them doctors listed in their directory were not taking him, he was told, “Well, they are supposed to.”

Florida CHAIN contacted ACS, the choice counseling providing company, on Reid’s behalf to see whether he could get assistance in finding a plan that better suits his needs, even after the 90 day deadline. One suggestion given by the field choice counselor referred by the Special Needs Unit was that he appeal the acid reflux medication decision, so Reid called Staywell again.

“When I called about appealing the medication decision, the plan operator was so rude. When I asked to speak to a supervisor to clarify what I needed to send them, I had to threaten to report her to Tallahassee before she transferred the call,” he said. “Since this Reform I can’t tell you how much more stressful my life has become.”

Reid is also rather sour on the Choice Counseling component of Medicaid Reform: “When I called at the beginning of the enrollment process, the operator assured me that ‘everything would remain the same’. Well, nothing has remained the same after reform,” he said. “When I commented to the Special Needs nurse who I thought might help me with the acid reflux medication problem, that it is a strain on the doctor to be administrating Staywell, she asked me if I was getting paid to say so.”

In Reid’s case, Medicaid Reform has not worked on many angles: the managed care plan, whose phone representatives have been rude and ineffective and whose Preferred Drug List does not include the medication he needs, and whose physician directory is outdated; the choice counselors who misinformed him and rather than being responsive to his needs have wondered as to his motives; and the Enhanced Benefit component, since he is still trying to get products he has been entitled to since December.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

State budget includes Medicaid dollars for low-income hospital Patients

2007-05-01T07:41:00.000-04:00

By Liz Freeman

Originally published — 1:00 p.m., April 30, 2007
Updated — 9:54 p.m., April 30, 2007

Florida hospital officials can breathe easier now that a critical source of funding for treating uninsured patients appears intact rather than on the verge of disappearing.

State legislative leaders have drafted a budget plan for the new year, which includes $81 million to continue funding a Medicaid program that helps hospitals treating large numbers of uninsured patients.

House and Senate leaders agreed during the weekend to allocate the money to the low-income pool program, which can be used to draw down more than $1.1 billion from the federal government in Medicaid funding for hospitals.

In addition, local governments contribute $723 million to the low-income pool program.

The budget plan was expected to be presented to lawmakers Monday as they enter their final week of the session.

The $81 million for the low-income pool program theoretically could face a line-item veto of Gov. Charlie Crist, but that isn’t anticipated.

“We believe he understands the value that hospitals provide in meeting the care needs of our uninsured patients,” said Rich Rasmussen, spokesman for the Florida Hospital Association.

Lee Memorial Health System in Lee County stands to lose $4.6 million if the Legislature doesn’t act to continue funding the program. The NCH Healthcare System would lose $932,000 and Physicians Regional Medical Center-Pine Ridge would lose $69,000.

The state’s low-income pool program was on shaky ground during the legislative session when a House budget committee allocated $65 million to continue funding the program but no such appropriation came out of the Senate. That forced the issue onto Senate leaders to add into their budget plan.

The state’s low-income pool program was created one year ago with a waiver by the federal government to help hospitals that face increasing unreimbursed costs for treating the uninsured who don’t quality for traditional Medicaid.

If the Legislature was to quit funding the state match to receive the federal dollars for the program, $209 million would disappear, causing further hardship to already overwhelmed emergency rooms and trauma centers.

Officials with Lee Memorial and NCH couldn’t be reached for comment Monday.

Florida Want Ads: Sound Health Care Leadership Needed ASAP!

2007-04-25T23:06:00.000-04:00

Andrew,

Thank you for sharing this information.

Do you get the sense that our lawmakers are throwing darts in the dark as they search for a good working solution to Florida's Health Care ills? My inquiry is not directed towards a specific proposal; but rather, it is an indication of my rising concern regarding Florida's propensity to praise a given reform measure only to have it fizzle because due diligence was not conducted.

By my observation, many hassles and expenses that Patients endure could be alleviated by making certain that our lawmakers follow the proper order of hypothesis testing. Namely, formation of the hypothesis should be followed by statistically sound data collection and analysis which either proves or disproves the initial hypothesis. Only then can a proper and educated decision be made regarding continuation or discontinuation of a specific reform measure.

Plain and simple, too many Patient lives are at risk for our lawmakers to alternately jump onboard and then abandon the "latest greatest" reform model.

Florida's Health Care arena is in desperate need of informed, unwavering leadership.

Sincerely,

Dr. Marion D. Thorpe, Jr.

Marion D. Thorpe, Jr., M.D., M.P.H.

-----Original Message-----
From: starbanner.com [mailto:tips@publicus.com]
Sent: Wednesday, April 25, 2007 11:39 AM
To: doc@marionthorpe.com
Subject: [MedicaidReform] Demise of Senior Care HMO model?

This is an article from Ocala.com.

Andrew Leone thinks you might be interested in this.

Link to the article:

http://www.ocala.com/apps/pbcs.dll/article?AID=@@2007704241507

A message to you from Andrew Leone:

Scroll down to article on Senior Care HMO proposal NOT getting to a vote this year.

Regards

Andrew Leone

andrewl@floridachain.org

Money Short For Hospitals, Poor

2007-04-21T11:31:00.000-04:00

By CATHERINE DOLINSKI The Tampa Tribune

Published: Apr 21, 2007

TALLAHASSEE - Rep. Aaron Bean opened Friday's negotiations over the state health care budget with a warning for patients and families.

"We've come to the reality that there's going to be a lot of folks that are going to go away empty-handed," said Bean, R-Fernandina Beach, the House's main budget writer for health and human services.

It was an ominous beginning for the joint conference committee, which is negotiating hot-button funding issues such as services for the developmentally disabled. Conference meetings continue today.

Funding for the disabled has risen to the fore of the budget battles, given the $153 million projected deficit at the Agency for Persons With Disabilities and the waiting list of thousands seeking services. Talk of budget cuts prompted a rally Thursday at the Capitol of hundreds of disabled people and their families. The event drew appearances - but no promises - from Gov. Charlie Crist and several leading lawmakers.

A Reality Check

Stark reality set in quickly Friday when Bean began the conference meeting with a presentation about the Agency for Persons With Disabilities. The number of disabled people served by the agency over the years has not kept up with its rate of spending, he said.

"A lot of folks think the solution for APD is just to appropriate new money," he said. "We don't think that's a solution in itself. We think that's just treating the symptom."

Bean's initial budget offer to the Senate reduced the House's original $1.17 billion proposal for the disabilities agency by $21.9 million.

That brought the House closer to the Senate's $1 billion appropriation and the agency's current funding level of nearly $1.1 billion. It drew protest from House Minority Leader Dan Gelber, who said the state needs to spend more of its revenue to plug the troubled agency's deficit, which partly is attributed to increased demand for services.

Gelber's concern stems in part from the House and Senate plans to overhaul one of the state's programs for the disabled. More than 19,000 people are waiting to enroll in the Home and Community-Based Services program, which provides up to 33 services and therapies. The chambers have proposed differing strategies to trim spending on the program by up to $120 million.

Bean said after the conference that he was leaning toward restricting spending per person but not the kinds of services offered - a concept embodied more in the Senate's approach than the House's. The Senate proposal would affect more people.

Bean said he's not settling on either plan yet.

One big-ticket item skipped Friday was funding for hospital treatment of the poor and uninsured.

For the first time, money that local counties and hospital districts send to the state will fall short of what's needed to draw down the maximum federal match.

IfFlorida fails to pitch in $65 million in state dollars, hospitals will lose $86 million in federal funding for Medicaid reimbursements and charity care this year.

The House budget sufficiently fills the gap, hospital advocates said, but the Senate plan omits the state money.

Bean said House and Senate leaders intend to negotiate the issue.

Hospital care of residents on Medicaid or without insurance entails a complex intermingling of local, state and federal funding.

If the Senate refuses to provide state revenue, hospitals could lose $209 million, said Jill Chamberlin, spokeswoman for House Speaker Marco Rubio, R-Miami.

Bay Area Would Feel The Appeal

Tampa General Hospital could lose $10.67 million, and All Children's Hospital in St. Petersburg risks losing $5.38 million.

"To me it's a major priority," said Sen. Nan Rich, D-Weston. "We need to put our general revenue in; this would hurt our hospitals too badly."

Rich is a longtime supporter of reinstating KidCare coverage of legal immigrants excluded from the state's insurance program for low-income children.

Despite the governor's support, she said, things are looking bleak.

The House agreed this year to lift the state's freeze on enrolling children of state employees and certain categories of legal immigrants, but so far it has provided funding only for the employees' children.

Covering either group of children costs the state extra because they do not qualify for federal matching dollars.

A plan to cover both groups was progressing through the Senate but hit a wall this week when a committee removed the language from its KidCare plan. Crist said Thursday he supports enrolling immigrant children, but no funding has emerged in either chamber.

Advocates said they hope House and Senate leaders will find $5 million for the initiative somewhere in the $71 billion state budget.

House and Senate negotiators are expected to take up the proposed $5 million for state employees' children next week.

Reporter Catherine Dolinski can be reached at (850) 222-8382 or cdolinski@tampatrib.com.

Medicaid for Kids Under Fire

2007-03-25T10:30:00.001-04:00

Medicaid for kids under fire
State lawsuit clears roadblock in bid to create improved care

By Jennifer Booth Reed
jreed@news-press.com
Originally posted on March 25, 2007

A STRAIN ON HOSPITALS
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

A few specialists thrive serving Medicaid clients

Lee nonprofit helps uninsured, Medicaid patients

State’s Medicaid list of doctors full of errors

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.

Medicaid Stories: A Front-Line View

2007-03-15T09:13:00.000-04:00

Medicaid helps, but getting it can be hard


Enlarge	By Tim Dillon, USA TODAY

Mike and Phyllis Zolotorow are among the approximately 50 million people who qualify for assistance through Medicaid. Because their son, Craig, is medically disabled, he qualifies for his own health insurance through Medicaid.

By Julie Appleby
USA TODAY
March 15, 2007

Things started spiraling down for Phyllis and Mike Zolotorow after he severely injured his bicep and shoulder in December 2003 while working as a shipping and receiving clerk. After Mike spent a year on disability recovering from two surgeries, his employer dropped his health insurance.

The couple were offered a chance to continue the employer insurance through a federal law known as COBRA, but Phyllis says it would have cost upward of $700 a month.

"It was something so ridiculous, we could not afford it," she says. "We had used up most of our savings."

But not long after, Mike suffered a massive heart attack, leaving the 52-year-old disabled and living on Social Security income.

FIND MORE STORIES IN: | |

Now, the Zolotorows are among the approximately 50 million people who qualify for assistance through Medicaid, a $313 billion-a-year federal-state program that provides health care coverage for low-income pregnant women, children, the disabled, some adults and many of the nation's nursing home residents.

Despite its wide reach, the program is not an all-encompassing safety net.

While the Zolotorows qualify as poor — his annual Social Security income of $11,280 puts them below this year's $13,690 federal poverty level for a couple — they earn too much to qualify for full assistance through their state's Medicaid program. They may have coverage in some months, but not others. And, because of complicated rules, they must actually go into debt before Medicaid kicks in.

Because states have flexibility in designing their Medicaid programs, eligibility rules vary by state. Coverage also depends on income, family size, employment status and whether an applicant is disabled or elderly. In the past few years, with enrollment increasing and state budgets under pressure, many states cut back Medicaid eligibility.

But an improving economy boosted state revenues last year and also slowed the growth of enrollment for the first time since 1999, according to an analysis by the Kaiser Family Foundation, a non-partisan research group. This year, 26 states plan to restore cuts, expand eligibility or make other changes, the report says.

Still, eligibility varies widely. In eight states, working, non-disabled parents in a family of three could qualify for full Medicaid assistance with an annual income of more than $33,000, according to data gathered by the Kaiser Family Foundation. Yet, in nine other states, parents in a three-person household would be disqualified with annual incomes between $3,000 and $6,000. Rules for the disabled also vary.

Single adults who never had children or have none living at home fare worst of all: Only 17 states offer coverage at all, and most provide only limited benefits to childless adults, Kaiser data show.

"We do not have a safety net of health insurance coverage in this country," says Alan Weil, executive director of the National Academy for State Health Policy, non-profit, non-partisan organization of state policymakers. "Where you live, your family structure and the nature of your illness determines what it is you're going to get."

A labyrinth of rules

The Zolotorows illustrate the complexity of those rules. They are eligible for partial coverage from Medicare, but only in six-month increments — and only if they amass medical bills equal to 56% of their income.

Here's how it works for the Zolotorows: The monthly income limit in Maryland for full assistance for a couple in their situation is $392 a month, according to documents given to the family by the Howard County Department of Social Services. Because Mike's Social Security checks total $940 a month, they must "spend down" the difference, or $528, minus an allowance of $20.

For "spend down" purposes, the Zolotorows don't actually have to pay all the bills, but they must owe the money to doctors and hospitals. The amount is then multiplied by six, to get a six-month total: $3,168, or 56% of their income. Once they accumulate that debt, Medicaid kicks in.

"They will cover things 100%, but only two to three months out of every six," says Phyllis, 55. "So we'll never get out of debt."

She estimates they owe several thousand dollars at the moment.

'You're having the big one'

Mike, who spent much of his career as an equipment manager for local baseball, soccer and basketball teams, was rushed by ambulance to the hospital in September 2005, barely able to breathe.

"You're having the big one," he recalls paramedics telling him. Once at the hospital, cardiologist Martin Albornoz could not believe he was still alive.

"He had the arteries of an 80-year-old," says Albornoz, who was able to put in a stent to prop open Mike's blocked artery. Later, he was transferred to another hospital, where he underwent a cardiac bypass operation last March.

A few days before his heart attack, Mike was on a walk when he felt so ill, he had to call his wife to come pick him up. But, lacking insurance, he refused her pleas to go the emergency room because he knew it would be costly.

The couple know how important health insurance is, as their son, Craig, was diagnosed as a toddler with a type of immune system disease which leaves him vulnerable to infections. Now 22, Craig also suffers from seizures and takes medication for high blood pressure and bipolar disorder. He developed a kind of cancer, Hodgkin's disease, at 10.

Coping with the intricacies of all of Craig's illnesses led Phyllis to quit her part-time job at a florist at a Giant supermarket in 1999 to help care for him.

Craig lives with his parents in their two-bedroom rented apartment and works part time as a photo technician at a CVS store. Because he is medically disabled, he qualifies for his own health insurance through Medicaid, which covers his medical visits and the seven medications he takes each day.

Filing for legal separation

At the time of his cancer in 1995, Craig was covered by insurance from Phyllis' job, but his medical care over the next two years tapped out the insurance plan's $250,000 lifetime cap on benefits, Phyllis says.

Between her part-time job at Giant and Mike's job, the couple made too much for Craig to qualify for Medicaid. So Phyllis filed for a legal separation from her husband — and Craig then qualified for Medicaid based on her income alone. After Craig turned 19 three years ago, the couple dropped the legal separation.

When Mike had his heart attack, the hospital helped him sign up for Medicaid, which covered the $64,000 hospital charge.

He gets his most expensive drug, a $400-a-month heart treatment, free from the manufacturer through an assistance program. And his doctor has helped him switch to low-cost generics for many of the rest of the 12 drugs he takes each day.

In about six months, the mandatory two-year waiting period for the disabled to qualify for Medicare will be up, and he will have health coverage through that federal program.

The couple praise the medical care they've been given, even as they worry about the future.

"It's an excellent program, if you can stay in it," says Phyllis of the state's Medicaid program.

Mike's cardiologist says he treats a number of uninsured patients. "It seems that the people who need insurance are the ones who can't get it. It's most common among the working poor," Albornoz says. "They have a job, but insurance is a luxury they can't afford. Then they get sick."

Mike, Albornoz says, is recovering and is now able to walk 2 miles a day. But his severe heart disease means he will never be able hold a job that requires regular physical demands.

If Mike had been insured, Albornoz says, he would have been more able to afford to come in for tests and may have learned earlier that he had heart disease, before the heart attack that disabled him.

And the Answer is... “I Don’t Know”

2007-01-29T11:48:00.000-05:00

The first tenet of Medicine taught to me at UNC-Chapel Hill many years ago:

If you don’t know the clinical answer, don’t guess; but rather, you should politely state “I don’t know.” At the earliest possible time, you should research the question, find the answer, and swiftly return with the correct information.

To those who ponder the present course of Medicaid Reform in Florida and are awaiting my input on the likelihood of success/failure for the pilot program, my answer is simply, “I don’t know.” It remains to be seen which direction of leadership our new Governor and Secretary of AHCA will pursue as they undertake the responsibility of implementing legislatively mandated Medicaid Reform in the Sunshine State. Most assuredly, the Medicaid Reform Advocates Coalition and other like-minded organizations and individuals are all hopeful that positive reform will occur in a manner that protects and promotes the delivery of sound, accessible, and affordable Health Care for Florida’s most vulnerable Patients. Furthermore, it is desirable for Health Promotion and Disease Prevention outreach and education to become heightened in the wake of Florida’s Medicaid Reform initiative.

Will Florida become a beacon amongst Medicaid Reform efforts throughout the Nation? I don’t know. Will Floridians be assured top-quality Health Care for all? I don’t know. Will mismanaged and neglectful treatment of Florida’s Medicaid community prevail with the new leadership brass in Tallahassee? I don’t know. Unlike the tenet taught to me in Chapel Hill, I cannot scurry around the corner and learn the answer to the preceding questions. Only time will tell.

In the interim, I encourage all Patients, Family Members, and Providers to share your thoughts on Medicaid Reform with the Medicaid Reform Advocates Coalition.

Categorically, I do know that we can make a positive difference by banding together for the betterment of Health Care delivery throughout the Medicaid community and throughout the State of Florida.

Sincerely,

Dr. Marion D. Thorpe, Jr.

Strictly my Opinion

2007-01-22T11:40:00.000-05:00

The following article is posted by Dr. Marion D. Thorpe, Jr. and is not intended to convey or suggest the collective belief of the MRAC; but rather, this article is intended to highlight the disgust felt by one man towards the ineptitude of America's approach to closure of the Health Care disparities gap. Until Medicaid Reform makes an earnest attempt to implement a true Patient-Driven system with premium focus on Health Promotion and Disease Prevention amongst all people, it will fail in Florida and throughout this Nation. The humane implications of "leaderless leadership" within the Health Care reform arena are astoundingly detrimental to America's infrastructure and future.

State Inmates Outlive People on Outside
State Prisoners, Particularly Blacks, Outliving People on Outside, Government Reports

http://abcnews.go.com/Politics/LegalCenter/wireStory?id=2811494

WASHINGTON Jan 21, 2007 (AP)— State prison inmates, particularly blacks, are living longer on average than people on the outside, the government said Sunday.

Inmates in state prisons are dying at an average yearly rate of 250 per 100,000, according to the latest figures reported to the Justice Department by state prison officials. By comparison, the overall population of people between age 15 and 64 is dying at a rate of 308 a year.

For black inmates, the rate was 57 percent lower than among the overall black population 206 versus 484. But white and Hispanic prisoners both had death rates slightly above their counterparts in the overall population.

The Justice Department's Bureau of Justice Statistics said 12,129 state prisoners died between 2001 through 2004.

Eight percent were murdered or killed themselves, 2 percent died of alcohol, drugs or accidental injuries, and 1 percent of the deaths could not be explained, the report said.

The rest of the deaths 89 percent were due to medical reasons. Of those, two-thirds of inmates had the medical problem they died of before they were admitted to prison.

Medical problems that were most common among both men and women in state prisons were heart disease, lung and liver cancer, liver diseases and AIDS-related causes.

But the death rate among men was 72 percent higher than among women. Nearly one-quarter of the women who died had breast, ovarian, cervical or uterine cancer.

Four percent of the men who died had prostate or testicular cancer.

More than half the inmates 65 or older who died in state prisons were at least 55 when they were admitted to prison.

State prison officials reported that 94 percent of their inmates who died from an illness had been evaluated by a medical professional for that illness, and 93 percent got medication for it.

Eighty-nine percent of these inmates had gotten X-rays, MRI exams, blood tests and other diagnostic work, state prison officials told the bureau.

On the Net:

Bureau of Justice Statistics report: http://www.ojp.usdoj.gov/bjs/abstract/mcdsp04.htm

My closing question: Why do incarcerated African-American males have more sound, accessible, and affordable Health Care than law-abiding African-American males?

Sincerely,

Dr. Marion D. Thorpe, Jr.

Video of Medicaid Reform Public Meeting

2007-01-10T02:05:00.000-05:00

Video of Medicaid Reform Public Meeting.

Consumers express their concerns and describe their experiences as medicaid recipients subject to Medicaid Reform in Broward County.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Powerpoint Explaining Medicaid Reform

2006-12-28T01:57:00.000-05:00

Powerpoint prepared by Florida CHAIN.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Advocates want tax to fund health care

2006-12-21T10:37:00.000-05:00

By LINDA H. LAMB
llamb@thestate.com

Health advocates who have campaigned for a cigarette tax hike hoped the money would benefit Medicaid programs serving low-income residents.

Some were upset Wednesday when Gov. Mark Sanford proposed that the tax money go for personal and business tax cuts.

“How disappointing,” said Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center.

“I would love for him to talk to real South Carolinians, maybe one of the 850,000 who are without health insurance.”

Teresa Arnold, legislative director for the South Carolina AARP, said the state has high insurance premiums, high rates of disease such as stroke and diabetes, and relatively low taxes.

“In light of these facts, why would we use these cigarette tax revenues to lower income taxes, when we could use them to expand health care coverage for the working uninsured?” Arnold said.

In 2002, a coalition of health advocates led by three of the state’s largest hospital systems — including Columbia-based Palmetto Health — commissioned a poll to gauge support for a cigarette tax hike. The poll found almost 76 percent of S.C. voters favored a higher cigarette tax if the funds would benefit Medicaid.

“Of course people want to deter smoking, especially in kids, but there’s even more support for dedicating the money to help Medicaid,” said Judy Cotchett Smith, Palmetto Health spokeswoman.

Matching federal funds would multiply the benefits for needy S.C. residents, Smith added.

Berkowitz said the state’s uninsured include 102,000 children. “Seventy thousand of them could be insured if we just had $19 million to $25 million” to expand eligibility for Medicaid, she said.

There’s a logical link between making cigarettes more expensive and making health care more available, Berkowitz said.

“Smoking increases health care costs for all, including costs for the Medicaid program,” she said.

Looking on the bright side was Patti Smoake, spokeswoman for the S.C. Hospital Association.

Her group supports a cigarette tax increase and believes “any money raised from that should go for health care needs in South Carolina, because there are so many,” Smoake said.

However, she expressed hope there still could be discussion with Sanford about using the money for health programs.

“We’re certainly glad to see that a cigarette tax is on his radar screen. We would like the opportunity to talk with him and the Legislature about how best to use that money.”

Reach Lamb at (803) 771-8454.

CIGARETTE TAXES

South Carolina could more than double its 7-cents per pack tax on cigarettes and still have the lowest rate in the nation. The national average is $1.

Here is a look at how other states’ taxes stack up.

In the Southeast:

Tennessee 20cents
Virginia 30cents
N. Carolina 35cents
Florida 33.9cents
Georgia 37cents
Lowest of 50 states and District of Columbia:

Virginia 30cents Kentucky 30cents

Tennessee 20cents Mississippi 18cents Missouri 17cents S. Carolina 7cents The highest:

New Jersey $2.575 Rhode Island $2.46 Washington $2.025 Maine $2.00 Michigan $2.00

SOURCE: Campaign for Tobacco-Free kids

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

AHCA Responds to "False Medicaid Reform" Article

2006-12-11T01:56:00.000-05:00

Dear Fellow Medicaid Reform Advocates,

I present the following letter to you in an effort to gauge consensus opinion about the present status of Medicaid Reform in the State of Florida. Your comments are highly valuable to me and will prove most helpful in determining the best course for future Medicaid Reform implementation. With the possibility of state-wide expansion of the reform movement, well over 2 million Patients will be directly impacted by Medicaid Reform treatment options and protocols. Of additional noteworthiness, Patient Family Members, Providers, and Health Care systems will also be affected by the course of Medicaid Reform in Florida. Collectively, we must remain focused on elevating the baseline Health Care status of all Floridians in a fiscally sound manner.

On behalf of Florida’s most vulnerable Patients, it is imperative that AHCA provides informed, caring, and compassionate leadership throughout the entire duration of Florida's Medicaid Reform effort.

Sincerely,

Dr. Marion D. Thorpe, Jr.
doc@marionthorpe.com

Letters: Medicaid reform having positive effects for patients

Palm Beach Post Editorial

Monday, December 11, 2006

In response to the editorial "False Medicaid reform" (Dec. 4): Denial is the last thing that the Florida Agency for Health Care Administration has shown toward the state's Medicaid program. In fact, under the leadership of Gov. Bush and the Florida Legislature, the agency publicly has showcased and thoroughly examined the shortcomings of the Medicaid program during the past two years, resulting in unprecedented reform of Florida's Medicaid program and philosophy.

Medicaid reimbursement rates are lower than competing rates, which makes finding physicians, especially specialists, difficult for Medicaid beneficiaries. The hard work of AHCA's local Medicaid office personnel to find care for those who come to them in need has helped many, but their abilities are limited.

Further, recipients should not have to call every doctor in an area hoping to find one to help and should have access to a wide network of doctors who are able and willing to provide them with high-quality care. In traditional Medicaid, the state has had no single entity to hold accountable for refusing care to beneficiaries.

We do now. Under Florida Medicaid reform, health plans are required by law to have an adequate network of primary- care physicians, specialists, dentists and all other health- care providers necessary to serve the needs of their enrolled population. Health plans now are responsible for helping individuals find and make an appointment with a physician. Reform plans are being extraordinarily proactive to identify access problems and resolve them, even outside their networks.

Real patient choice is also key to Florida Medicaid reform. Beneficiaries now can choose a health plan tailored to their unique health-care needs, and they are making those choices. Although The Palm Beach Post asserts that "choice" limits health benefits, traditional Medicaid services continue to be provided under reform. In addition, reform offers new services never provided by Medicaid before - at no cost to the state.

The truth is, Medicaid reform already has given more than 100,000 people in Broward and Duval counties the opportunity to take charge of their health care. Now, they have a real chance to receive the quality and timely medical care they deserve.

CHRISTA CALAMAS,

secretary

Florida Agency for Health Care Administration

Tallahassee

Medicaid dental program needs reasonable rates to draw dentists

2006-11-27T20:39:00.000-05:00

Published - November, 27, 2006

Medicaid dental program needs reasonable rates to draw dentists

State Sen. Durell Peaden, R-Crestview, astutely summed up the situation with the state's Medicaid dental program: "You can't reform what you're not funding appropriately to begin with."

He's right.

For Gov. Jeb Bush and the Legislature, "reform" too often seems to mean cutting services and putting program management in the hands of private companies that then look to further "reform" the system by carving their profit margin out of what's left.

The problem of too few dentists in the Pensacola Bay Area not accepting Medicaid patients looks pretty simple: The program already pays so little that it costs dentists money to accept them.

"Dentists can't afford to keep their doors open just getting 10 cents on the dollar," Peaden pointed out.

It is fine to talk about the need for dentists to step up to meet social and professional responsibilities, but expecting dentists to lose money in doing so isn't fair. Charity freely given is one thing -- and if nothing else, it is tax deductible. But saving the state money by asking dentists to absorb a loss is something else.

We expect many dentists would be happy to accept Medicaid patients even if it meant not earning as much as they make from their regular patients. Or, if they could at least depend on breaking even.

But running the program by stiffing dentists is not the way. The natural result is for dentists to decline to participate.

Which, frankly, might be the point.

Either way, it marks a significant failure on the part of state government.

The Medicaid dental program is a limited one. It provides basic services that provide relief for problems that, left untreated, can debilitate sufferers and lead to worse problems -- the kind that send people without insurance to emergency rooms, the most costly kind of health care.

For adults, Medicaid covers only dentures and emergencies, such as tooth extractions. Children are offered more services, which is critical. Dental needs ignored in childhood can become lifelong problems.

Medicaid was designed to provide a basic level of health care for a segment of society unlikely to get it elsewhere. They are either unemployed or hold low-paying jobs that don't provide health insurance.

States face large and growing costs for Medicaid, so it is reasonable that they look to limit costs. But making the system unworkable isn't "reform."

Right now, a combination of bare-bones public and private resources are available to serve Medicaid patients. That includes health departments in Escambia and Santa Rosa counties, Sacred Heart Health System, five area dentists who accept children as patients, and the Florida Baptist Convention, which provides visits once a year by a mobile office that offers only extractions.

Bringing reimbursement rates up to a reasonable level should bring needed dentists into the program.

-----------------------------------------------------------------------------------

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Medicaid Spending Sees First Decline

2006-11-27T07:33:00.000-05:00

Medicaid spending sees first decline

Posted 11/26/2006 11:09 PM ET

By Dennis Cauchon, USA TODAY

Medicaid spending has declined unexpectedly this year, the first drop since the health program for the poor was created in 1965.

The historic reversal will free up billions of dollars in state budgets. Medicaid has been the fastest-growing expense for states over the past 10 years.

Medicaid spending fell 1.4% in the first nine months of the year compared with the same period a year ago, according to the Bureau of Economic Analysis. The drop was even greater — an unprecedented a 5.4% decline — after adjusting for the rate of health care inflation.

The spending has been reduced by cost-controlling efforts and a shift of some prescription-drug expenses to Medicare, the federal health program for the elderly.

"States have made really aggressive changes in how care is managed in Medicaid," Arizona Medicaid Director Anthony Rodgers said. "Every state has taken a different approach, but the success can be seen almost everywhere."

Medicaid provides health care to 56 million poor Americans. The federal government sets broad rules for the program and pays 57% of the expense. States run the program and pay 43% of the cost.

The program is on track to spend $300 billion in federal and state money in 2006, the Bureau of Economic Analysis reports.

Medicaid is separate from Medicare, which insures 42.5 million elderly and disabled. That program — run entirely by the federal government — will spend about $384 billion this year, up 15.6%.

Some Medicaid savings are the result of shifting costs to the federal government's Medicare program. The new Medicare prescription-drug benefit pays most pharmaceutical costs for 6 million elderly poor who used to have their bills paid by Medicaid. Under the new drug plan, states reimburse Medicare for some money saved, but not all.

This complicated cost shifting between the two programs makes it impossible to know precisely how much Medicaid cost cutting is simply shifting expenses to the federal program. A USA TODAY analysis estimates that Medicaid spending would have been about flat — or down 4% after adjusting for inflation — without the new federal drug benefit.

Substantial Medicaid savings resulted from many small cost-containment policies adopted in recent years. The changes include shifting the elderly from nursing homes to less-costly home health care, cracking down on fraud, refining the management of high-cost patients (such as those with AIDS or hemophilia) and cutting some payments to hospitals and doctors.

"This is a unique event. No doubt about it. And there are lot of reasons for it," said Vic Miller, senior fellow at the Federal Funds Information for States, a research group sponsored by states.

Key examples:

•Ohio spent about 10% less on Medicaid from July through October than a year earlier. The $310 million reduction includes $37 million less paid to nursing homes and $32 million less to hospitals. "It's many things, not one sea change," Ohio Medicaid spokesman Jon Allen said.

•Michigan spent $1 billion less than budgeted and $311 million less than it spent a year earlier.

•New York planned for a 7% spending increase this year but now predicts a 3.8% increase.


Posted 11/26/2006 11:09 PM ET

Hope for millions without health coverage

2006-11-13T18:18:00.000-05:00

Hope for millions without health coverage

By Ricardo Alonso-Zaldivar, Times Staff Writer
9:41 AM PST, November 13, 2006

WASHINGTON -- Alarmed by the relentless erosion of employer-sponsored medical benefits, the health insurance industry today unveiled a proposal to extend coverage to more than 46 million uninsured persons.

Combining solutions favored by Democrats with some that Republicans have backed, the proposal by America's Health Insurance Plans calls for providing coverage within three years to all uninsured children, currently numbering about 8 million, and within 10 years to virtually all adults.

The trade group's plan would rely on a mixture of expanded federal and state programs and tax credits for workers and their families to purchase private health insurance.

"We should transcend the rigidly partisan political debates that have led only to stalemate," the group said in a statement accompanying the proposal. "Our nation needs a pragmatic approach driven by a broad understanding of the nature of the challenge and a strong commitment to the goal of covering all Americans."

AHIP, as the group is known, represents almost 1,300 companies that provide health insurance policies, including traditional fee-for-service plans and managed-care plans such as health maintenance organizations.

The insurance industry said its plan would cost the federal government $300 billion over 10 years, but the proposal lacked specifics on how it would be financed. Other estimates of providing coverage for all have been higher, $50 billion to $80 billion a year. By comparison, the federal government already spends more than $530 billion a year on two giant healthcare programs, Medicare for the elderly and Medicaid for the poor.

The high cost of health insurance is the main reason for the rising number of uninsured Americans. The Kaiser Family Foundation's 2006 healthcare survey found an average cost of almost $11,500 a year for an employer-sponsored family plan. Employers, particularly smaller businesses, have been shedding coverage as costs have risen, and many individuals find it too costly to purchase a plan on their own.

With Democrats taking over Congress next year, many policy leaders in the medical community, labor unions and even corporate boardrooms are hoping to revive a national debate that has been dormant since the collapse of the Clinton administration's plan more than 10 years ago.

"The election shows that Americans pay attention and they're willing to support change," Dr. Raymond J. Gibbons, president of the American Heart Assn., said Sunday at the group's annual scientific conference in Chicago. "There has been woefully little public discussion and, as a result, we haven't had the kind of national dialogue that's needed to find a solution."

Polls show that Americans strongly back guaranteed coverage for all, but support melts away if it would mean significantly higher taxes — suggesting that the next debate on overhauling healthcare will focus on controlling costs.

Already, U.S. employers say the high cost of health insurance for their workers puts them at a competitive disadvantage in the global marketplace. General Motors, for example, spent $5.3 billion for healthcare in 2005, more than it did on steel.

The health insurance industry's proposal would build on the current system, a mix of federal and state programs, employer plans and individuals buying their own coverage.

It calls for the expansion of the federally funded State Children's Health Insurance Program to cover all children in families with incomes up to twice the federal poverty level. That would help most children in low-income working families, since a family of four making up to $40,000 would be able to receive benefits.

Similarly, the plan would expand Medicaid eligibility to adults earning up to the federal poverty level, which is $9,800 for a single person.

The idea of using existing government programs to solve the problem of the uninsured has strong support among Democrats. But the insurance industry proposal also calls for two new tax breaks, a kind of approach traditionally favored by Republicans.

A new $200-per-child tax credit, or up to $500 per family, would go to middle-class families who could show that their children were covered. The plan also calls for the creation of universal health accounts, a kind of tax break that would make it more affordable for the self-employed and those not covered by an employer to buy coverage on their own.

ricardo.alonso-zaldivar@latimes.com

Bloomberg News contributed to this report.

Gov. rule change could be costly for thousands with chronic illnesses

2006-11-10T01:10:00.000-05:00

By Bob LaMendola
South Florida Sun-Sentinel Health Writer
Posted November 10 2006

Because of tangled government eligibility rules, up to 37,000 Floridians with chronic and costly illnesses are at risk of losing low-cost Medicare and Medicaid prescription coverage. As a result, they will face sharply higher medical bills.

Patients and advocacy groups fear the big bills will drain thousands of dollars every month from people who can afford it least, possibly forcing some to skimp on medicine and doctor visits -- for at least a few months.

"I'm just able to scrape by now. If I had to pay more, I don't know what I would do," said Bruce Bernstein, a Boynton Beach heart transplant recipient who is disabled at age 59. "I might lose my home."

The problem springs from complex eligibility rules. These patients -- about 2,000 in Broward County and 1,000 in Palm Beach County -- earn too much to qualify for regular state Medicaid available to low-income people, but because of large medical bills, they were eligible for a state "medically needy" program that paid all their costs.

This year, medically needy patients were moved into Medicare's new drug program, and pay subsidized prices of $0 to $5 per prescription. But because Medicare now covers the bulk of their drugs, most of them no longer will qualify as medically needy on Jan. 1. That's the Catch-22.

As a result, these patients will also lose eligibility for the Medicare discounts and must pay regular drug co-pays.

If that happens, Bernstein said his out-of-pocket costs for drugs would top $1,000 a month, a hard hit to his disability income of about $2,000. Now, in a Medicare HMO, he pays $45. In 2005, on medically needy status, he paid nothing.

Those affected by the change are among the sickest people in the state, with chronic conditions such as organ transplants, HIV/AIDS, cancer and heart disease. Some need more than $3,000 of medication monthly.

State and federal officials said some medically needy people do not realize their special coverage could end on Dec. 31, even though agencies are sending letters and activists are spreading the word.

"There are going to be some very, very upset people, and some are going to be clueless," said Miriam Harmatz, an attorney at Florida Legal Services in Miami. "They're going to go to the drugstore on Jan. 2 to pick up their prescriptions expecting to pay $2 and it's going to be hundreds of dollars."

Florida officials said they do not know how many medically needy patients will be affected or how much they will spend.

Some will be able to remain on the medically needy plan because they still have high bills, and others will re-qualify for subsidized Medicare drug prices because their annual incomes fall below $14,700 ($19,800 for a couple).

But those who do not qualify will lose part or all of their present coverage and will have to hunt for Medicare health plans or drug plans with low premiums and co-pays, said Sybil Richard, assistant secretary for Medicaid operations.

"Some will have problems, but we feel there are options to keep people in good health care coverage," Richard said.

On a positive note, Richard said, those patients who are forced to pay very large medical costs in 2007 can requalify for Medicaid's medically needy program the next month.

Once that happens, they will also requalify for the subsidized drug coverage from Medicare, restoring their present status, said Renard Murray, an associate regional administrator for Medicare.

"It's not dire straits for these folks," Richard said.

But health care advocates remain concerned. Applying and getting reapproved for two government programs could take at least two months, during which time the patients would be paying thousands of dollars out of pocket.

Bill Rettinger, a Fort Lauderdale activist disabled by severe arthritis from an auto accident as well as asthma and diabetes, said his out-of-pocket costs for drugs and doctor visits will top $1,100 per month out of his disability check of $1,300. This year, under Medicare, he is paying about $300 a month.

"I'm figuring out which bridge I'm going to live under," Rettinger said.

Advocacy groups led by the Florida Coalition for Transplant Survivors have started a petition asking state legislators to make it easier to qualify as medically needy. Now, patients do not qualify until their medical bills absorb all but $200 of their monthly incomes.

In addition to Medicaid's medically needy group, other low-income patients are at risk of losing subsidized prescriptions next year. Medicare sent letters to 46,000 Floridians -- 623,000 across the nation -- warning people they will not be automatically renewed for subsidies and must reapply. While a large number of them could easily requalify, officials and advocates worry some people will fail to reapply and lose out, because they mistakenly think they are supposed to be dropped, fail to notice the letter or belong to hard-to-reach groups, such as the mentally ill and homeless.

Bob LaMendola can be reached at blamendola@sun-sentinel.com or 954-356-4526 or 561-243-6600, ext. 4526.

What Kind Of Health Care System Do Floridians Want?

2006-10-24T23:02:00.000-04:00

After viewing tonight’s Florida gubernatorial debate, I am left to ponder the present state of Health Care for Floridians. Categorically, many of Florida’s most vulnerable Patients are in need of sound, accessible, and affordable Health Care. Humane Health Care must be coupled with fiscal responsibility in order to ensure that the State of Florida can deliver Quality service over the long-haul.

The nature of my outreach to you is not intended to be political in nature; but rather, a call to arms to ensure that we elect leaders who value the importance of Health Care. Make your vote count on November 7^th by choosing substance over baseless political promises. Collectively, we can fix the present ills of modern-day Health Care in a manner that guarantees Quality Health Care for all Floridians.

Sincerely,

Dr. Marion D. Thorpe, Jr.

Marion D. Thorpe, Jr., M.D., M.P.H.
Chairman
Medicaid Reform Advocates Coalition

www.floridamedicaidreform.org

From: Citizens' Health Care Working Group [mailto:healthcare@pfidc.org]
Sent: Tuesday, October 24, 2006 5:00 PM
To: doc@marionthorpe.com
Subject: What Kind Of Health Care System Do Americans Want?

What Kind Of Health Care System Do Americans Want?

The Citizens’ Health Care Working Group has just concluded its work and prepared and sent final recommendations to the President and the Congress. Five congressional committees are required to hold hearings on them. The recommendations build on the discussions with and advice from thousands of Americans like you.

Read the full report, including the final recommendations, on the Working Group’s web site, www.CitizensHealthCare.gov now.

The office of the Citizens’ Health Care Working Group has closed; however, there are numerous resources available, both at our web site and across the entire web. Keep informed and involved in the health care debate; engage with others who want change in our health care system.

What happens next is up to you.

Medicaid Spending Rises Only Slightly

2006-10-11T12:25:00.000-04:00

Medicaid Spending Rises Only Slightly
Some States Will Expand Program
By Christopher Lee
Washington Post Staff Writer
Wednesday, October 11, 2006; A03

Medicaid spending rose by 2.8 percent in fiscal 2006, the smallest increase in a decade, according to a study released yesterday by the nonprofit Kaiser Family Foundation.

At the same time, state tax revenue grew by 3.7 percent as the economy continued to improve, the survey of 50 states and their Medicaid directors found.

Together those trends signal that the state-federal program that pays for health care for the poor and disabled is emerging -- at least temporarily -- from a period in which many states limited eligibility, benefits and reimbursement rates for health-care services in a drive to corral costs. For 2007, only five states plan to restrict eligibility, while 26 indicated they will restore benefits, relax application and enrollment restrictions and undertake new outreach efforts.

"The program continues to grow, but it is not out of control," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured.

"We now see that as the economy is improving that the states are looking at how they can best meet the needs of their citizens using the tools they have available to them."

With total annual costs of more than $300 billion, Medicaid serves more than 50 million people and its fortunes rise and fall with the economy. In tough economic times, when more people are out of work and hurting financially, Medicaid rolls swell. But that is when it is hardest for states to pick up their 40 percent of overall Medicaid costs, because a slumping economy also sends state tax revenues plummeting. (The federal government pays the balance of the costs.) The crunch typically leads Medicaid officials to scramble to impose cost-containment measures as part of broader efforts to rein in overall state spending.

Everything tends to turn around when the economy improves, with state coffers more flush and fewer people eligible for Medicaid. While 2002 and 2003 were lean years for states, the past two were better.

The slower growth in Medicaid spending documented by the Kaiser report was a product of both the improving economy and continued cost-containment efforts, Rowland said. Spending growth would have been even slower, but states had to fork over billions of dollars to help pay for the new Medicare drug benefit, which covers about 6 million low-income people who used to get prescriptions through Medicaid, the report found.

Even in good times, there is upward pressure on enrollment as the population ages and an increasing number of people lack health insurance. Medicaid enrollment grew by 1.6 percent in fiscal 2006, the lowest rate since 1999, the survey found. It does not take many people to drive up costs, however. About 4 percent of the Medicaid population, generally the elderly and disabled, accounted for 48 percent of the program's expenditures in 2001, the survey showed.

Anne Marie Murphy, Medicaid director for Illinois, said officials there have combined expansion and outreach in recent years with a new emphasis on prevention and managing health-care services.

"We have been very focused on controlling utilization," she said. "We want people to get health care, but to get necessary health care. We want to spend our money wisely and be a prudent purchaser of care."

Although pressure to hold down costs continues, many states plan to expand coverage in 2007.

In California, about 95 percent of Medicaid-eligible children are already enrolled -- but officials will go after the uninsured 5 percent, said Stan Rosenstein, the state's deputy director of medical care services. "The governor has put in major funding for outreach, and we are making major simplifications to our application and redetermination process," he said.

© 2006 The Washington Post Company

Medicaid and People with Developmental Disabilities - From the ARC of the United States

2006-10-06T19:15:00.000-04:00

Source: ARC of the United States

Florida’s Investment in Medicaid is Critical to Residents with Mental Retardation, Cerebral Palsy, and Related Disabilities

Medicaid is a federal/state program that provides health, community based and institutional long-term care services and supports, for children and families, the elderly, and people with disabilities. In 2000, more than 2.24 million Florida residents received services through Medicaid, including 460,214 people with disabilities.

As the national economy has weakened and as Florida struggles to balance its budget and provide critical and life-saving services for its residents, The Arc of the United States and United Cerebral Palsy—national organizations that provide a voice for persons with mental retardation and cerebral palsy—have compiled information to help the public understand the essential role of Medicaid in providing critical services and supports to Floridians with mental retardation, cerebral palsy and related disabilities. As the state cuts its budget and prioritizes programs, care must be taken not to hurt our most vulnerable residents by cutting eligibility for Medicaid or eliminating critical Medicaid services.

Continued on Site

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

WellCare dominates Jacksonville Medicaid market

2006-09-19T09:11:00.000-04:00

WellCare dominates Jacksonville Medicaid market
The Business Journal of Jacksonville - September 15, 2006
by M.C. MoeweStaff writer

JACKSONVILLE -- With nearly 8,000 Medicaid recipients having joined the state's pilot program in Duval County so far, Tampa-based WellCare Health Plans Inc. continues to dominate the market with four times the members that Shands Jacksonville's newly launched Medicaid product has attracted.

"I'm reasonably pleased with the numbers," said Doug Chaet, vice president of managed care for Shands HealthCare. "This is very early in the process."

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Medicaid Choice Counseling

2006-09-15T11:18:00.000-04:00

As the Outreach Manager for the Florida Medicaid Program Choice Counseling, I want to take a moment to say that it is our sincere desire and ultimate goal to provide every Medicaid beneficiary the resources it needs to make an informed choice regarding the selection of the health plan that they will receive their benefits through. Not every beneficiary is in need of choice counseling. But for those who do, we have made non-biased, third-party counseling available at no cost through our call center and through face-to-face interaction with Field Choice Counselors at conveniently located organizations throughout Broward and Duval. Counseling is available in group or individual settings. We will also do a home visit if necessary.
Finally, we offer what we call Private Seminars. This type of counseling is for any Community Based Organization or Agency that is serving Medicaid beneficiaries. We ask the organization to advertise the event to its clients and help coordinate as well as provide the case managers or supervisors who are involved in the individual's desicion making. We have been very succesful in a short period of time reaching out to the Mental Health Community through this type of counseling and encourage any provider of services to Medicaid beneficiaries to contact us regarding securing our counselors to come to your location. I would also like to offer the opportunity to ask questions about our program. I will respond as soon as I see it.

I can be reached at 904-696-9071

Please call me if you or your clients are experiencing any issues regarding the selection of your health plan. I will do everything I can to help you resolve it.

Percent of Children (1-17) with Emotional, Developmental, or Behavioral Problems that Received Mental Health Care, 2003

2006-09-15T10:15:00.002-04:00

Source: state health facts

Report

Percent of Children (1-17) with Emotional, Developmental, or Behavioral Problems that Received Mental Health Care, 2003

Received Mental Health Care/Counseling of Some Type during Past 12 Months:
FL: 55%
US: 59%

Data are for 2003. These are the estimated percentages after applying the sampling weights.

Data based on The National Survey of Children's Health, sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration, U.S. Department of Health and Human Services.The NSCH examines the physical and emotional health of children ages 0-17 years of age. Special emphasis is placed on factors that may relate to well-being of children, including medical homes, family interactions, parental health, school and after-school experiences, and safe neighborhoods. For more detailed analyses of the survey's findings, see the Data Resource Center on Child and Adolescent Health (DRC); available at http://www.nschdata.org/Content/Default.aspx.

Sources: Child and Adolescent Health Measurement Initiative, 2005, National Survey of Children's Health, Data Resource Center on Child and Adolescent Health, retrieved August 17, 2006; available at www.childhealthdata.org.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Medicaid's Role for People with Disabilities

2006-09-15T10:04:00.000-04:00

Source: Information provided by the Kaiser Commission on Medicaid and the Uninsured
Publication Number: 4027 Publish Date: 2003-12-11

This primer is on Medicaid's role as the major provider of health coverage for non-elderly persons with disabilities and on the policy challenges that lie ahead. It also provides short profiles of people with disabilities from across the country.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Experts Urge Lawmakers to Help Ease Growing Mental Health Crisis in Seniors

2006-09-15T09:12:00.000-04:00

By Moises Mendoza, Times Staff Writer
September 15, 2006

WASHINGTON — Senior citizens have high rates of mental illness and the country's highest suicide rate when compared with other age groups, a panel of mental health experts told a congressional committee Thursday.

Appearing before the Senate Special Committee on Aging, the experts said poor access to mental health care, inadequate training for primary care physicians and even apathy among seniors was contributing to a growing mental health crisis among those older than 65.

Seniors account for a fifth of all suicides — many by firearms; nearly 40% show signs of depression, but only about 3% seek psychological help, the experts testified.

"I think you could probably characterize the situation as a national embarrassment," said psychologist David Shern, president and chief executive of the National Mental Health Assn., an advocacy group in Alexandria, Va.

Fewer than half of all adults with symptoms of depression are screened accurately by their primary care physicians, he said, urging changes in clinical and training practices.

He also called for more research funding to study suicide risks among the elderly — a view that all of the panel's experts endorsed.

Dr. David C. Steffens, a geriatric psychiatrist at Duke University Medical Center, said that when money gets tight, some seniors stop taking antidepressants rather than give up medications to treat physical ailments.

But, he added, several projects looking into innovative approaches to seniors' mental health care showed promise.

In one study conducted in New York, Philadelphia and Pittsburgh, depression care managers — usually nurses or social workers — worked with physicians to identify patients who showed signs of depression and follow up on their care.

Steffens said participants in this program were less likely to think about suicide than people in a control group.

In another study, covering five states, clinical specialists in depression worked with patients in a primary care clinic, reducing their depression symptoms by as much as half when compared with patients who did not receive specialist care, Steffens said.

As the hearing ended, Sen. Gordon H. Smith (R-Ore.), the committee chairman, said that improving mental health services for seniors should be a top priority.

"There really should be no higher issue for us in Congress than to fix this," he said.

--------------------------------------------------------------------------------
moises.mendoza@latimes.com

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Report calls for outreach to uninsured Hispanics

2006-09-15T08:49:00.000-04:00

Sept. 14, 2006, 11:31PM
Report calls for outreach to uninsured Hispanics
Only 1 in 4 across the U.S. covered by jobs

By MY-THUAN TRAN
Copyright 2006 Houston Chronicle Washington Bureau

WASHINGTON — The growing number of Latinos without health insurance could be reduced if the government offered small businesses tax incentives to provide coverage, a Hispanic advocacy group said Thursday.

Many Latinos hold low-wage jobs in small businesses that are not as likely to offer health insurance, according to a report issued by the Latino Coalition. The group said only one in four Latinos nationwide has employer-provided insurance.

The report also recommended that the government offer tax credits, which would reduce taxes by a dollar for every dollar put into health savings accounts. These accounts use a mixture of savings and insurance to
help people cover medical expenses.

The main barrier to adequate health care for Latinos — along with poverty, language and low education levels — is not having health insurance, said Robert de Posada, the president of the Latino Coalition.

The percentage of Latinos without insurance is among the highest among all ethnic groups, the group said. More than half of Texas' uninsured population is Latino, according to the 2000 Census.

The report calls for programs that are tailored to Latino culture and Spanish language.

For example, Hispanics face a higher risk of chronic diseases, such as diabetes and obesity, than non-Hispanics. When making health policy, the government should take these differences into account, the report said.

"Not all programs affect all populations the same way," said Glenn Melnick, a professor at the University of Southern California who co-authored the report. "We have to understand the different languages and cultures to make programs effective."

The report called for more funding for community clinics that offer free or low-cost health care in places with high Latino populations.

The government should also make efforts to increase the low enrollment of Latino children in federally funded health programs, the report said. One-fifth of Latino children lack health insurance.

The Latino Coalition said the government needs to find ways to get uninsured Latino children into programs such as Medicaid or the State Children's Health Insurance Program, which provides coverage to uninsured low-income children.

"These strategies are doable and easy to achieve," de Posada said. "We are tired of waiting for people to act."

my-thuan@chron.com

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

South Florida Sun-Sentinel Editorial Board

2006-09-14T09:42:00.000-04:00

September 14, 2006

ISSUE: Health official gives an upbeat assessment on Medicaid reform.

With the Medicaid experiment in Broward and Duval counties off and running, the program's administrator must watch for snags, not read early signs of a smooth transition as a complete success.

Tom Arnold, the state's Medicaid chief, said that since the start of Medicaid reform on Sept. 1, his agency hasn't heard a single complaint from or about a program recipient having any problems. Maybe so, but Arnold would serve this experiment better by keeping an eye out for trouble, even if the first weeks of Medicaid's new tack in caring for the poor and elderly seem to be operating well enough.

Watchfulness is appropriate especially since several health-care advocates of Medicaid patients have painted a less rosy picture. They talk of recipients bewildered by a new process that requires them to choose among 13 health plans, not to mention the lack of basic information, such as which drugs are covered and limits the plans impose on care.

Florida has taken a bold step in addressing the increasing costs of Medicaid, a joint state and federal program that in recent years has seen its operating costs go through the roof. This month, the state began a new managed-care system involving 210,000 Medicaid recipients in Broward and Duval counties.

The hope is that the two-county pilot program will save money and enhance services. The fear is that it will leave those who need more extensive -- read expensive -- medical care in a lurch.

What is a certainty is that confusion often follows major changes in health-care programs. It occurred recently with the Medicare prescription drug program and it's very possible that there will be similar perplexity as the Medicaid pilot program continues.

The reform has put Florida in the national spotlight. So, sticking with an upbeat outlook can be tolerated to a point. Now, however, is not the time for a snap assessment that may ultimately come across as insensitive, or worse, dismissive.

BOTTOM LINE: It's still way too early to dismiss legitimate concerns about the change.

Copyright (c) 2006, South Florida Sun-Sentinel

Visit Sun-Sentinel.com

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New Requirements for Citizenship Documentation in Medicaid

2006-09-06T10:27:00.000-04:00

Source: Kaiser Commission on Medicaid and the Uninsured

New Requirements for Citizenship Documentation in Medicaid

This fact sheet provides information on the new federal requirement that all U.S. citizens and nationals applying for or renewing their Medicaid coverage provide documentation of their citizenship status and examines the implications for Medicaid beneficiaries and the states.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

The rising pharmaceutical expenditures for treatment of mental health disorders

2006-09-06T09:50:00.000-04:00

Source: Florida Center for Medicaid and the Uninsured

"Mental health care drugs represent as much as a quarter of overall prescription drug costs within state Medicaid programs..."

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

The Medicaid Reform Advocates Coalition-Partial List

2006-09-06T09:06:00.000-04:00

Florida CHAIN:

Florida CHAIN is a statewide network organization dedicated to improving the health and wellbeing of Floridians, especially disenfranchised constituencies. Florida CHAIN works by linking and building the capacity of communities for national, state, regional and local advocacy.

Florida CHAIN works toward access to quality health care, empowering people to actively shape their world by participating in civic life and actively caring for each other’s wellbeing, including Florida’s most vulnerable. Florida CHAIN’s bi-weekly electronic newsletter “CHAIN Reaction” keeps readers informed on the health care policy issues and events that affect us all, including issues related to Medicaid Reform.

Contact: Andrew Leone, andrewl@floridachain.org
954-684-9895
www.floridachain.org

Center for Independent Living of Broward

The Center for Independent Living of Broward is a tax-exempt nonprofit whose mission is to enhance the lives and independence of people with disabilities in Broward County. As part of our Advocacy Program, we are working with the Medicaid Reform Advocates Coalition to address Medicaid reform's effect on people with disabilities.

Contact: Marc Dubin, Esq., Director of Advocacy, mdubin@pobox.com.

Center for Independent Living of South Florida, Inc.
Center for Independent Living of South Florida, Inc.'s mission is to empower people with disabilities in Miami-Dade County to reach their highest level of independence and to advocate for systemic change that results in dignity, equality, inclusion, integration, independence, and choice for all people with disabilities. We provide information technology training, competitive job placement, supported job placement, transition from school to community and work, transition from institutions to the community, sign language instruction, information and referral, peer support, disability rights training, independent living skills training, self and systems advocacy, transportation assistance, housing assistance, and assistive technology recycling. For the public, we provide disability awareness training, accessibility surveys, American Sign Language interpreters, Braille printing, and other alternative communication formats on a fee for service basis. We are involved with Medicaid Reform to assure that the civil rights of consumers with disabilities are protected to the maximum extent possible and that they are aware of their rights, understand how to navigate the system, and will not be adversely impacted by it.

Kelly Greene, Executive Director
Center for Independent Living of South Florida
6660 Biscayne Blvd., Miami, Florida 33138
Voice: 305-751-8025
TTY: 305-751-8891
Fax: 305-751-8944
www.soflacil.org
www.cilfla.blogspot.com

Care Broward, Inc.
Care Broward is centered on the belief that Florida's most vulnerable Patient population deserves Top-Quality, Accessible, and Affordable Health Care. Furthermore, we are committed to developing proper input for all participating Providers, and implementing fee schedules that encourage Provider advocacy for Preventive Health Care services.

Care Broward's mission is anchored by our promise to maintain open and effective communication with
* Florida's Medicaid recipients
* All participating Providers and Patient Advocacy groups
* The Florida Agency for Health Care Administration
If you are a Medicaid Patient, contact us today so that we can make certain you receive the Health Care you need and deserve.
Dr. Marion D. Thorpe, Jr.
www.carebroward.com
info@carebroward.com
954-607-2423

National Association on Mental Illness (NAMI)

NAMI is a Not for Profit, 501 (c) 3, organization dedicated to helping the families of those with Mental Illness with positive support and the coping skills to deal with this disorder. Almost everybody with a major mental illness is impoverished and therefore on Medicaid, Medicare or both; and therefore will very likely have to make a choice as to which Medicaid Reform plan they will join. However Mental Illness interferes with the very human organ that is required to make such an informed decision, namely the brain.

Phil Ketchum, the NAMI Broward representative, in addition to being a member of the Medicaid Reform Advocates Coalition, is an 8 year Board Member of NAMI Broward County, a member of the governing body of South Florida Evaluation and Treatment Center, formerly a member of the Statewide Advocacy Council, and now a member of the PAIMI (Florida) Advisory Council, a volunteer at South Florida State Hospital and a member of the advisory committee of the Broward County FACT (Florida Assertive Community Treatment) team. He is an Advocate who concentrates on improving the Mental Health system to better aid in the recovery of those with severe Mental Illness.

Contact: Phil Ketchum
Tel: 954-731-9421, Mobile: 954-647-3495
phillk@bellsouth.net

Broward County ACORN

A local affiliate of Florida ACORN (Association of Community Organizations for Reform Now!), Broward County ACORN builds power for low- and moderate-income families by engaging in a variety of activities including traditional community organizing, issue advocacy, political and electoral work, corporate campaigns, and direct action. Broward ACORN brings Medicaid recipients together through community outreach to address the needs of this community through collective action. For more information contact Nicholas Graber-Grace, Head Organizer at 954-484-8052.

The Human Services Coalition

The Human Services Coalition works to empower individuals and communities to create a more just and equitable society by promoting civic engagement, economic fairness, and access to health and human services that address unmet needs.

Work on Medicaid Reform:

HSC is the CHAIN LINC (Local Initiative Networking Community) in Miami; together with our local coalition members we are able to maintain ongoing communication with our state delegation and encourage over 3,000 subscribers to take action through our e-advocacy newsletter "Call to Action". Through other avenues such as "First Friday Luncheons", and the Health Access Task Force (a local committee developed in partnership with the Countywide of Office of Health Care planning among other groups) HSC works to raise awareness about the inevitable changes that are in the pipeline for Dade County as medicaid reform makes its way.

For contact info, feel free to have folks call the Human Services Coalition and ask for the Policy Coordinator, 305-576-5001, ext 42.

Florida Independent Living Council, Inc.

1018 Thomasville Road, Suite 100A
Tallahassee, FL 32303
(850) 488-5624 voice/TTY
(877) 822-1993 toll free
(850) 488-5881 fax
mg@polaris.net

What is FILC?
The Florida Independent Living Council is a statewide council established by federal mandate and Florida Statute. It consists of 15 voting members, who are appointed by the Governor. Other members include ex-officio representatives of the Division of Voc Rehab and Blind Services and the Florida Spinal Cord Injury Resource Center. In compliance with state law, a majority of the voting members are persons with disabilities. Additional representatives are from Centers for Independent Living, Advocacy, other consumer or independent living organizations and various state agencies that are impacted by Title VII of The Rehabilitation Act.

What is FILC's purpose?
FILC's purpose is to promote independent living opportunities for persons with disabilities throughout the state of Florida. This includes the promotion of a direct service philosophy that is consumer controlled and directed.

FILC's responsibilities?
The primary responsibility of the Council is to meet its various legal obligations that are covered in both the Federal Rehabilitation Act of 1973 and Florida Statutes, Chapter 413, Part II.

These responsibilities include developing a State Plan for Independent Living. FILC accomplishes this in partnership with consumers, other independent living centers and organizations, the Department of Vocational Rehabilitation and the Division of Blind Services.

The Council also works to insure:
1) That persons with disabilities have an opportunity for input into the development of a state plan for Independent Living Services.

2) That the independent living needs of people with disabilities are identified and met; and

3) That advocacy on behalf of independent living programs and consumers is initiated and carried out.

Contact: Molly Gosline (850) 488-5624 voice/TTY mg@polaris.net

Independent Living Resource Center of Northeast Florida.

Founded in 1991, the ILRC is guided by its mission statement: "To empower all people with a disability (as defined in the American's With Disabilities Act (ADA) or Rehab Act of 1973), to live independent and self-empowered lives."

The Independent Living Resource Center of N. E. Florida (ILRC), has been serving people with disabilities for over 20 years. The ILRC is a consumer driven, community based, non-residential, 501 (c) (3) private not-for-profit organization. We serve as a resource agency serving people with disabilities in 5 counties throughout Northeast Florida, including: Duval, Baker, Clay, Nassau and St. Johns. Funding for the program and services are provided by Department of Education, Rehabilitation Service Administration, Division of Vocational Rehabilitation, Social Security Administration, City of Jacksonville Public Service Grant Administration, The United Way of Northeast Florida, The ABLE Trust and other private foundations.

We are working with AHCA and they will be providing group Choice Counseling to our consumers on 11/13 @ 1:00. Also, I am working with them to provide a .5 FTE so we can have a Choice Counselor of our staff.

Contact information:

Matthew J. Motko, M.B.A.
Executive Director
Independent Living Resource Center of NEF
2709 Art Museum Drive
Jacksonville, Florida 32207
904.399.8484 X23
mattm@cilj.com
www.cilj.com

The Advocacy Center for Persons with Disabilities, Inc.

The Advocacy Center for Persons with Disabilities, Inc., is a non-profit organization providing protection and advocacy services in the State of Florida. Our mission is to advance the dignity, equality, self-determination and expressed choices of individuals with disabilities.

Contact information: For consumers please contact Gloria Weiner at 954.967.1493 or Intake at 1.800.342.0823. Other Medicaid Reform inquiries please contact Gayle Miller, Esq., also at 954.967.1493.

Coast to Coast Legal Aid of South Florida, Inc.
Coast to Coast Legal Aid of South Florida, Inc. is a non-profit law firm which provides free legal assistance to income eligible individuals in Broward County in certain areas of the law. Our program will provide legal assistance to income eligible persons in Broward County who have legal problems related to Florida Medicaid Reform. We will assist clients with a variety of legal problems including but not limited to access to health care, denial of Medicaid benefits /services, reduction of benefits/services, and cessation of Medicaid benefits /services .
Contact Information:
Coast to Coast Legal Aid of South Florida, Inc.
491 N. State Road 7
Plantation, FL 33317
Telephone: (954) 736-2400

FLORIDA TRANSPLANT SURVIVORS COALITION, INC.
Our mission is to serve, support, and educate the most vulnerable citizens about the healthcare programs available to them and monitor Legislation for possible harmful law changes. Currently, we are working with legislators advising them of the impending disaster Medicaid Reform will have. All Transplant Hospitals and case workers are getting weekly updates on the issues.
Contact information: www.floridatransplantsurvivots.org or
FTXSC2004@cs.com

www.floridamedicaidreform.org

Government Report Finds Healthcare Privacy Breaches Rampant

2006-09-06T08:39:00.000-04:00

Source: Information Week

Over 40% of federal health insurance contractors and state Medicaid agencies reported experiencing a privacy breach involving personal health information in the past two years, according to a Government Accounting Office (GAO) report released on Tuesday.

The contractors and agencies collectively have access to medical data covering more than 100 million Americans, the report says.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com

www.floridamedicaidreform.org

Georgia Medicaid, PeachCare Beneficiaries To Enroll in HMOs Friday Despite Concerns

2006-09-01T12:38:00.000-04:00

Friday, September 01, 2006
Georgia Medicaid, PeachCare Beneficiaries To Enroll in HMOs Friday Despite Concerns Over Partial Rollout of Plan

Georgia's Medicaid and PeachCare programs on Friday will enroll hundreds of thousands of beneficiaries in HMOs "despite complaints that the program has become an administrative and medical nightmare in areas where it has been tried so far," the Florida Times-Union reports (Larrabee, Florida Times-Union, 8/31). Gov. Sonny Perdue's (R) reform plan was implemented on June 1 in the Atlanta, Columbus and Macon areas, where about 600,000 beneficiaries were moved from fee-for-service plans to HMOs. The HMOs are being administered by Amerigroup, Centene and WellCare (Kaiser Daily Health Policy Report, 4/28). State officials on Wednesday said the complete rollout of the program will occur on Friday as planned, although the total number of Medicaid and PeachCare beneficiaries enrolled in HMOs will be fewer than the 1.2 million originally predicted. Officials said the total number will be only 847,000, in part because the state began checking beneficiaries' citizenship status and incomes in January. The Atlanta Journal-Constitution reports that "[m]any doctors have cited payment and patient-care problems experienced when the managed care program started in metro Atlanta and central Georgia, and they fear they will surface as the program expands this week" (Miller, Atlanta Journal-Constitution, 8/31). A group of Georgia physicians last month filed a lawsuit against the HMOs alleging that they have not paid providers for millions of dollars in outstanding claims (Kaiser Daily Health Policy Report, 8/17). Critics of the program also say the HMOs have been slow to grant permission for medical treatments (Florida Times-Union, 8/31).

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com or by calling Gloria Weiner at the Advocacy Center for Persons with Disabilities,Inc - (954) 967-1493.

www.floridamedicaidreform.org

Early Experiences of Medicare Beneficiaries in Prescription Drug Plans

2006-08-28T10:01:00.000-04:00

Report from the Kaiser Foundation.

"....SHIP directors who participated in the focus group reported significant casework related to data system errors resulting in beneficiaries being enrolled in a plan other than the one they had selected, being enrolled into multiple plans, or inadvertently disenrolled from a plan...."

"...Other issues include concerns about marketing practices by some Part D plans, prior authorization requirements, beneficiaries’ limited knowledge of Medicare Advantage products, emerging concerns related to the "doughnut hole," and problems with the automatic enrollment of the dual eligible population...."

continued

Visit www.floridamedicaidreform.org

Sun Sentinel: Funding gap leaves thousands of severely disabled residents on waiting list

2006-08-27T09:07:00.001-04:00

News Article

By Bill Hirschman
South Florida Sun-Sentinel
Posted August 27 2006

Thousands of severely disabled people are not getting the care they need because a state in-home assistance program that could help them maintain their independence hasn't been adequately funded.

More than 3,100 people have been on a waiting list since 2004, a figure that outraged some legislators who say they were never told about the list and didn't know the program was in trouble.

The Disabled Adult Medicaid Waiver provides a nurse or aide to directly help Floridians between ages 19 and 59 living on their own and struggling with debilitating illnesses ranging from stroke to multiple sclerosis. Aides also provide respite for relatives caring for disabled adults. For some clients, the alternative is a state-funded nursing home or assisted living center.

continued....

Study: Percentage of physicians not accepting new Medicaid patients rises

2006-08-26T21:59:00.000-04:00

News Story:

Doctors Taking Less Medicaid Patients

By KEVIN FREKING
The Associated Press
Thursday, August 17, 2006; 1:38 AM

WASHINGTON -- Many people who rely on government health insurance for the poor have to search harder to find a doctor and increasingly are going to large practices, a study shows.

Officials say Medicaid's reimbursement rate is the biggest reason that it is getting more difficult to locate doctors who take new patients under the program. On average, reimbursements are 69 percent of what Medicare pays and even lower compared with what private insurers pay.

Doctors frequently complain about the administrative hassles. For example, physicians often have to get approval before prescribing medicine or conducting tests.

Overall, the percentage of physicians not accepting new Medicaid patients has risen from about 19.5 in the mid-1990s to about 21 over the past few years. The change was much more pronounced among solo and small group practices.

It is not clear whether the trend has prevented Medicaid participants from getting medical care, but the potential is there if it continues, the study's authors said.

"Many of the large Medicaid providers are located in areas where enrollees tend to live, such as inner cities and medically underserved areas," according to the Center for Studying Health System Change, which conducted the study.

The center compared telephone surveys that it periodically conducts with doctors to reach its findings. It compared the survey from 1996-97 with one from 2004-05. In the earlier survey, 29 percent of solo physicians reported no new Medicaid patients. Nearly a decade later, 35.3 percent of solo physicians reported accepting no new Medicaid patients.

A similar trend was found in small group practices where the percentage of doctors not accepting Medicaid patients grew from 16.2 to 24 percent. Small group practices consist of up to nine doctors.

Dr. J. Edward Hill, immediate past president of the American Medical Association, said government cuts to Medicaid have made it harder for physicians to provide care.

"This unsettling data comes as little surprise given Medicaid's high administrative costs and low payment rates, while the overhead costs associated with practicing medicine continue to increase," Hill said.

He also warned that fewer doctors will want to take on older people as new patients if the federal government reduces reimbursement rates for doctors serving Medicare beneficiaries, as has been proposed for next year.

The Washington-based center describes itself as a nonpartisan policy research organization that focuses on health care issues. It is funded mainly by The Robert Wood Johnson Foundation, a health advocacy organization.

___

On the Net:

Center for Studying Health System Change: http://www.hschange.com

© 2006 The Associated Press

Resources on Medicaid Policy Changes -- Kaiser Commission on Medicaid and the Uninsured

2006-08-26T21:43:00.000-04:00

Resources on Medicaid Policy Changes in the Federal Budget Reconciliation Bill

The Foundation's Kaiser Commission on Medicaid and the Uninsured has collected resources related to the Medicaid policy changes in the budget reconciliation law, Deficit Reduction Act of 2005.

Information About Evaluation of Medicaid Reform

2006-08-26T21:34:00.000-04:00

Evaluation of Medicaid Reform

Contractor: University of Florida, Department of Health Services Research, Management and Policy

Agency Contract Number: MED027

Contract Period: 12/19/05-06/30/10

Summary:

This contract is for the design and implementation of an independent Medicaid Reform Evaluation Study. The goals of the evaluation are specifically intended to align with the goals of Medicaid Reform. As a consequence, the evaluation is expected to adapt to the evolution of Medicaid Reform and the goals thereof as that process moves towards contracts, agreements, and other aspects of program implementation. ..... Projects to be conducted include:

Organizational analyses

Utilization and payment analyses; and

Quality of care, outcomes, and patient satisfaction assessment.

Continued

Governor Bush's Comments on Medicaid Reform 12/10/05

2006-08-26T21:21:00.000-04:00

Posted on Sat, Dec. 10, 2005

FLORIDA GOVERNMENT
Medicaid reform benefits Broward patients

BY JEB BUSH
www.myflorida.com

On Thursday, the Florida Legislature passed significant legislation to begin a historic statewide reform of Florida's Medicaid program. This legislation will offer more choices to Florida Medicaid participants and flexibility to providers to respond to the diverse needs of the more than two million Floridians who rely on Medicaid.

The first phase of the reform plan will be implemented in Duval and Broward counties. Thanks to the hard work and vision of the Legislature and the Agency for Health Care Administration, thousands of patients in these counties will soon have the opportunity to receive better healthcare and costs will become more predictable, allowing the state to better manage spending.

We will expand Medicaid reform to the rest of Florida within five years after closely reviewing results and best practices in the pilot counties.

This reform will empower participants to choose coordinated healthcare plans that best meet their needs, while spurring innovation, efficiency and improvements in the quality and access of care.

Florida's model will use time-honored market principles to drive better results. We want to improve health outcomes for the more than two million vulnerable, elderly and disabled Floridians who depend on Medicaid by enhancing their access to quality care and creating incentives for providers and consumers to focus on prevention.

By doing so, we will stabilize the program's costs while maintaining current eligibility and broadening the scope of services. We will empower consumers with unprecedented choice and unleash the innovative and competitive talents of providers.

Participants, with the assistance of counselors, will choose the best plan for them. Or, they can choose to opt out of Medicaid plans and use their state-paid premium to purchase insurance in the private market.

We will also give participants credits for approved health-related expenses such as smoking cessation classes and other health services not covered in their plan. This will encourage participants to engage in healthy lifestyle choices, improving health and lowering acute care costs.

Healthcare providers will be able to compete for participants by offering innovative care, convenient networks and optional services. This will harness the power of the marketplace to drive inefficiency and fraud out of the system.

In a competitive market environment, healthcare providers will search for ways to raise the quality of care and lower costs. And by introducing incentives to reward healthy lifestyle choices and giving consumers more input into their healthcare, we will improve the health of our citizens.

In addition, the inefficiencies caused by lack of choice, lack of focus on preventive care and lack of competition have made Medicaid's growth unsustainable. This year Florida's Medicaid Program will cost a record $15.5 billion -- nearly 25 percent of the state budget. Since 1999, our Medicaid costs have risen 120 percent.

Florida's average annual general revenue growth since 1999 is 5.5 percent. However, that robust rate of growth cannot keep up with Medicaid costs that have risen an average of 13 percent each year during the same period. If left unaddressed, Medicaid could consume nearly 60 percent of the state's budget by 2015, draining valuable resources away from education, public safety and other services.

This growth is not only unsustainable; it creates no corresponding increase in the quality or availability of services for the people who rely on Medicaid for healthcare.

Effective Medicaid reform will happen by giving states like Florida the power and the flexibility to build a Medicaid system for the 21st century. On Thursday in Florida, we took an important step not only to better serve Floridians but also to offer a model for other states to follow and give millions of citizens the healthcare they deserve.

Jeb Bush is governor of Florida.

FLORIDA MEDICAID REFORM - National Conference of State Legislatures

2006-08-26T21:09:00.000-04:00

Source: National Conference of State Legislatures
August 25, 2006

The Florida legislature took a major step in May to change the nature of the Medicaid program in the state, with an eye to controlling future program growth and introducing greater benefit flexibility for providers and consumers.

With passage of SB 838, the legislature set the state on the path to a new defined contribution managed care model to be pilot tested in two counties after federal approval of a 1115 demonstration waiver. A “defined contribution” plan means a fixed premium paid to the provider organization per plan member, rather than a “fixed benefit” model under which the provider is reimbursed for the delivery of specific services.

SB 838 calls for the Florida Agency for Health Care Administration (AHCA) to create a capitated (fixed payment) managed care system for all Medicaid recipients in fee-for-service or other managed care systems and in the MediPass (the statewide primary care case management system) program. No Medicaid-eligible populations are to excluded, although the bill calls for AHCA to develop special “service delivery alternatives” to meet the specific needs of certain disability groups. 1

In partnership with the Department of Elderly Affairs, AHCA is also directed by the legislation to create an integrated (acute and long-term care services) fixed-payment delivery system for elderly Medicaid recipients. Medicaid funding for services provided to people age 60 or older will go into the demonstration project in two areas of the state, with voluntary enrollment to be tested in one of the areas. To be excluded from the pilot are persons age 60 and older with developmental disabilities in the community or in institutions, and persons in that age group in AIDS, traumatic brain injury, and spinal cord injury waiver programs.

Continued.....
We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Washington Post Article on Medicaid Reform 6/12/06

2006-08-26T12:23:00.000-04:00

Washington Post article on Medicaid Reform

States' Changes Reshape Medicaid
New Restrictions Aim to Save Money

By Amy Goldstein
Washington Post Staff Writer
Monday, June 12, 2006; Page A01

After winning greater freedom from federal Medicaid rules, states are moving aggressively to transform the nation's largest public health insurance program, adding fees, restricting benefits and creating incentives for patients to take responsibility for their health.

The changes are just beginning in several states that are being watched closely by governors nationwide. Those changes are reshaping Medicaid, which covers 55 million poor and disabled Americans, so that the program more closely resembles private insurance, rather than a social welfare system run with a strong, central government hand.

Starting July 1, West Virginia will phase in a redesigned form of Medicaid that requires patients to sign a "member agreement," promising that they will keep doctors' appointments, take prescribed medicine and not overuse hospital emergency rooms. Patients who refuse to sign or to follow the rules will be eligible for less care.

Kentucky is dividing its Medicaid patients into four categories, depending on their health and their age, with different benefits for each group. Most adults will face higher co-payments for medical services and new limits on prescription drugs. But patients who sign up for a "disease management" program eventually will be able to earn credits toward extra "get-healthy benefits," such as eyeglasses or classes to quit smoking.

Florida, meanwhile, will privatize part of its Medicaid system in September, directing patients in Jacksonville and Broward County to pick from 19 health plans, each offering different services. In a departure from how states have reimbursed doctors or health plans, Florida health officials will rate the health of every Medicaid patient in the two communities and pay for only as much care as officials predict they should need.

continued....

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com or by calling Gloria Weiner at the Advocacy Center for Persons with Disabilities,Inc - (954) 967-1493.

www.floridamedicaidreform.org

Our Blog has an easier-to-remember address: www.floridamedicaidreform.org

2006-08-26T09:12:00.000-04:00

Please tell others about our new address. www.floridamedicaidreform.org.
Thank you.

We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com or by calling Gloria Weiner at the Advocacy Center for Persons with Disabilities,Inc - (954) 967-1493.

Miami-Dade - Dental HMO flawed, study finds

2006-08-22T08:21:00.000-04:00

Dental HMO flawed, study finds

Columbia University reports a Medicaid pilot project is not justifying its budget, while the dental providers complain that the fee level is low.

BY JOHN DORSCHNER

jdorschner@MiamiHerald.com

While Atlantic Dental insists it's doing a good job providing care to poor kids in Miami-Dade County, a study just released by Columbia University concludes the Medicaid pilot project has cost taxpayers ``the same amount for less care and less quality.''

The study by Burton L. Edelstein, a professor of health policy, reports that in the first year of the pilot the dental budget for Medicaid in Miami-Dade increased 1 percent (from $14.9 million to $15.1 million) while the average number of annual dental visits per enrolled child dropped by 61 percent.

Meanwhile, one of the largest providers of dental services under the program, the Community Health of South Dade Inc., known as CHI, said it planned to drop out of the program and no longer serve the dental needs of 6,000 Medicaid kids because the plan pays only $4.25 per child per month.

''We can't continue to provide service for that amount,'' said Brodes Hartley Jr., CHI's chief executive.

Lourdes Tome-Rivas, vice president of operations for Atlantic Dental Inc., or ADI, said the company is being unfairly criticized. The measured drop in services is caused by dentists not reporting all the work they do, she said. They have little motivation to report what they do because they get paid in advance, whether they perform the work or not.

Tome-Rivas pointed to a University of Florida survey, released last month, which found that 80 percent of Medicaid recipients interviewed said they had ''no problem'' getting a dentist they were happy with. She said critics charged unfairly that survey could not be trusted, while at the same time accepting the survey of dentists that showed 57 percent were dissatisfied with the program.

''The biggest difficulty is a funding issue,'' said Marcio Cabrera, an ADI director. ``People say they're upset with ADI. But they are really upset with the funding.''

Cabrera contrasted the Medicaid pilot with Healthy Kids, another state-funded program in which parents pay sliding premiums based on annual income. Though the benefits in the two programs are not directly comparable, ADI gets about $10 a month per kid in Health Kids -- twice the rate for Medicaid. ``And we don't get any complaints with Healthy Kids.''

Under the Medicaid project, each dentist is assigned several hundred kids and gets paid $4.25 a month -- $51 a year -- for each. The Florida Dental Association maintains that's not enough, and critics say the only way the dentists can make money on the plan is to limit their treatment of Medicaid kids.

Still, ADI executives say they're not demanding more money from the state in their new two-year contract, which is scheduled to start next month, and Medicaid official Tom Arnold said increased funding is not a possibility because the basic goal of the pilot project basic was to control soaring Medicaid costs.

That cost-containment has hammered CHI, which says it has lost more than $400,000 a year due to the pilot project, which started July 1, 2004. As a federally qualified health center, serving the uninsured and the poor, CHI used to receive $129 a visit each time a Medicaid child was treated by one of its six full-time dentists or several hygienists.

In effect, the $129 reimbursement served as a subsidy for all the uninsured care the clinics provided, and the $4.25 a month per kid doesn't come anywhere near the salaries of the dentists and hygienists. ''We're struggling every day to make ends meet,'' said CEO Hartley, saying he may have to lay off dentists.

Medicaid spokeswoman Krista Moody said federal regulations state the CHI subsidy didn't apply to programs like ADIs. ``It is a business decision made by CHI as to whether or not they can continue their participation.''

If CHI drops out, the 6,000 children will then be assigned to other dentists in the ADI plan who are willing to do the work for the $4.25 a month.

The Columbia study, funded by the Community Voices Miami project at the Collins Center for Public Policy, relied on data reported by dentists to ADI. It said simple teeth cleanings, which had numbered 75,911 under the old fee-for-service plan, dropped by 59 percent to 31,106 under the new dental plan.

Community Voices acknowledged underreporting might account for part of the drop, but ``it is unlikely that the measurable declines in quality are due solely to poor reporting.''

Cabrera said ADI is trying to do a better job getting dentists to report accurately. ``At the end of the day, it is our responsibility.''

For a month, as a test, ADI offered dentists an extra $30 per cleaning if they reported the service, and there was a huge spike in reported cleanings, but the Medicaid contract doesn't allow that kind of payment regularly, and the test was quickly stopped.

ADI has a call center where operators call Medicaid recipients, urging them to go to dentists and even makes appointments for them, but 35 percent or 40 percent don't show up for the appointments, according to Miguel A. Montilla of ADI.

Moody, the Medicaid spokeswoman, said a contract was being drawn up that will extend the ADI pilot another two years but will require more accurate reporting.

Understanding Florida's Medicaid Reform

2006-08-22T00:06:00.000-04:00

Article About Medicaid Reform

Source: Florida Tax Watch December 2005

Enhanced Benefit Account Services Program - upcoming trainings

2006-08-21T23:53:00.000-04:00

Source: AHCA

You will receive information on the activities that will earn enhanced benefits for you. When you complete one of the activities, credits will be deposited into an account for you. You will be able to access the credits in that account to pay for over the counter health-related supplies that are not already covered by Florida Medicaid, such as vitamins. If you leave Florida Medicaid coverage, you may still use the remaining credits in your enhanced benefit account to pay for health related supplies.

The Agency for Health Care Administration announces all future Enhanced Benefits Advisory Panel meetings.

DATES AND TIMES:

September 5, 2006
9:30 am-12:00pm October 17, 2006
9:30 am-12:00pm October 3, 2006
9:30 am-12:00pm
September 19, 2006
9:30 am-12:00pm October 31, 2006
9:30 am-12:00pm

PLACE:
Agency for Healthcare Administration
2727 Mahan Drive
Building 3
Conference Room C
Tallahassee, FL 32308

Those not able to attend in person may call the conference telephone number (850) 414-1711.

GENERAL SUBJECT MATTER TO BE CONSIDERED: The Enhanced Benefit panel will discuss issues related to the technical aspects of the Enhanced Benefit program, under Medicaid Reform. Anyone needing further information, or special accommodations under the Americans with Disabilities Act of 1990, should write to the address given below or call (850) 488-3560. Special Accommodations requests under the Americans with Disabilities Act should be made at least seven days prior to the Public hearing.

A copy of the agenda may be obtained by writing: Joshua Davis, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #48, Tallahassee, FL 32308.

--------------------------------------------------------------------------------

We are interested in hearing from Medicaid Recipients

2006-08-19T22:35:00.000-04:00

Are you a Medicaid recipient in Broward County or Duval County? If so, we are interested in hearing from you.

We want to learn of your experience with Medicaid Reform, and want to work with you in helping you to better understand what Medicaid Reform means for you.

If you are interested in talking with us, please send an email to medicaidreform@pobox.com.

South Florida Business Journal Article About Medicaid Reform 11/21/05

2006-08-19T12:27:00.000-04:00

Florida Medicaid reform to begin

South Florida Business Journal - October 21, 2005

With the federal government approving Florida's plan to begin privitizing its Medicaid program, Broward County is to be one of the first areas in the state to see changes.

The U.S. Department of Health and Human Services has said Florida Medicaid beneficiaries may choose managed care plans for their health care needs.

The program is designed to provide Medicaid beneficiaries who enroll in managed care plans access to better-quality health care services, while also allowing state officials to maintain a reasonable rate of program growth, HHS said.

Florida, HHS added, requested the program after determining its Medicaid growth rate -- 13 percent a year for the last six years --- was unsustainable. This year, Medicaid spending is projected to take up 25 percent of the state's budget, or more than $15 billion.

The demonstration program is to begin in two counties, Broward and Duval, in July 2006. Statewide implementation is to follow. The demonstration is to run through June 30, 2011.

Medicaid beneficiaries in the program are to select from a group of state-approved managed care plans that will compete for their business.

In addition to having a choice of managed care plans, beneficiaries may also choose to opt out of Medicaid altogether. Under this scenario, a person or family would receive subsidies for their share of the cost to purchase employer-sponsored insurance.

The demonstration is also to establish an "enhanced benefit account" program. This would provide incentives to enrollees who take part in activities that promote healthy behavior, such as weight management, smoking cessation and diabetes management.

A $1 billion-a-year fund is to to help the state pay safety-net providers caring for the uninsured.

Article about Medicaid Reform by Andrew Leone of Florida CHAIN and Responses

2006-08-19T02:19:00.000-04:00

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).
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Read response of Christa Calamas here

Christa Calamas is Secretary of the Florida Agency for Health Care Administration in Tallahassee.

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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

Florida Medicaid Reform Choice Counseling How to Get Ready

2006-08-19T02:07:00.000-04:00

Florida Medicaid Reform Choice Counseling How to Get Ready
Source: ACS

What beneficiaries can do to get ready for Medicaid
Reform:
–
Make sure the Department of Children and Families or Social Security has the most up-to-date information!
–
Think about what Medicaid services are most critical to you and your family’s health care needs.
–
Think about services that Medicaid does not cover at present which would be of most benefit to you and your family. Are these services offered by a New Reform
plan?
–
Ask your providers what Reform plans they participate with.

Medicaid Reform and People with Disabilities - Comments of the Advocacy Center

2006-08-18T23:42:00.000-04:00

Advocacy Center Medicaid Reform Public Hearing Statement
February 11, 2005

Circle of One Marketing

2006-08-18T23:37:00.000-04:00

Melissa Dunn joins Circle of One Marketing as Project Manager on Community Health Initiatives

Westside Gazette

Originally posted 7/14/2006

June 15, 2006-Miami, Fl. - Circle of One Marketing has just added Melissa Dunn as Project Manager to “the Circle”. Circle of One Marketing is a minority owned full service advertising and marketing company whose expertise in connecting their client base with the emerging African American and Caribbean markets has earned them a host of high profile, A-list clients.

As Project Manager, Ms. Dunn’s primary focus will be working on outreach and marketing for the much anticipated State of Florida Medicaid Reform initiative in Broward County. This effort is being administered by the Agency for Healthcare Administration (AHCA) and executed by ACS Healthcare, who Circle of One Marketing has partnered with on this important project.

Ms. Dunn brings over 6 years experience as the Director of Community Health Initiatives and Health Systems for the American Cancer Society of New York City and the Manhattan Breast Health Partnership. She holds a Bachelor of Science degree in Sociology from Judson College and has completed some graduate work in Public Administration at the University of Miami. A veteran to the business of health care, Ms. Dunn has quickly established her ground and rapport with Broward’s community, health care and faith based organizations.

Melissa Dunn’s comments, “Everyone, regardless of their income, ethnicity or social status should have access to quality health care. It can mean the difference between life and death. Joining the Circle of One team on this important Medicaid Reform project allows me to follow my heart and positively affect the community’s access to healthy choices in South Florida.”

Suzan McDowell, President and CEO of Circle of One Marketing states “Melissa’s strong background in community health and outreach, coupled with her passion for access to health care for all made her a natural for our team and for this particular scope of work. We’re all about “getting it done” for our clients and we’ve seen that Melissa embodies that spirit as well.”

Medicaid Reform Brochure from AHCA

2006-08-18T22:16:00.000-04:00

Florida Medicaid Reform
Source: AHCA

An improved system of care delivery that will bring more choice to Florida
Medicaid beneficiaries. Beginning in July 2006, beneficiaries in Broward
and Duval Counties will be the first to direct their own health care under
Florida’s Medicaid program. Florida Medicaid Reform will not change who
receives Florida Medicaid. The current eligibility categories and income and
asset limits will be the same.

Frequently asked questions and AHCA's answers can be found here.

Anyone needing further information, or special accommodations under the Americans with Disabilities Act of 1990, should call (850) 488-3560. If TDD service is needed to call this number, Medicaid beneficiaries can call (800) 955-8771 for assistance.
If TDD service is needed to call the choice counseling hotline, call 1-866-467-4970.

Letter from AHCA to Medicaid Recipients

2006-08-18T22:07:00.000-04:00

JEB BUSH, GOVERNOR ALAN LEVINE, SECRETARY

2727 Mahan Dr i v e • Mail S top #1
Tallahassee, FL 32308

Dear Florida Medicaid Beneficiary:

Beginning in July 2006, there will be changes to Florida Medicaid in Broward and Duval Counties. These changes are needed to better meet your health care needs. These changes are called “Medicaid Reform”.
Medicaid Reform will allow you to choose the health care plan that best meets your health care needs. The health care plan you choose must offer services, like doctor visits, health screenings, lab work and other treatment when you medically need them.
The changes being made to Medicaid will NOT change who is eligible for services and will not increase what you pay out of your pocket when you receive services. We believe these changes will improve Medicaid.

In this envelope is a brochure which will tell you more about the changes being made to Medicaid and the choices you will have. You do not need to do anything right now. When it is time for you to choose a health care plan, the Florida Medicaid Program will send you a packet in the mail. The packet will give you all the information you need to receive choice counseling services. This is a free service that will help you choose a health care plan. If you would like to attend a training to learn more about Medicaid Reform, you can sign up for training on the web at:http://ahca.myflorida.com/Medicaid/medicaid_reform/index.shtml

Sincerely,
Alan Levine
Secretary

How to Reach a Choice Counselor

2006-08-18T22:02:00.000-04:00

Beginning July 1, 2006, you can get more information about Medicaid Reform by speaking to a choice counselor at:

1-866-454-3959

TDD 1-866-467-4970

Monday – Friday: 8:00 am to 7:00 pm

Saturday : 9:00 am to 1:00 pm

Information About Choice Counseling

2006-08-18T21:54:00.000-04:00

Choice counselors throughout Duval and Broward Counties are available to Medicaid recipients to assist them with making their plan decision through group presentations, one-on-one counseling and via telephone. Materials are available in multiple languages as well as Braille.

Counselors are properly equipped with the resources to effectively educate special needs populations, the elderly and those of different cultures or linguistic backgrounds, including English, Spanish and Haitian-Creole. Sign language interpreters and other language specialist are also available.

With the recent addition of Access Health to the list of available health care plans, thirteen are currently approved to serve Medicaid beneficiaries in the counties.

Source: AHCA
http://www.fdhc.state.fl.us/Executive/Communications/Press_Releases/pdf/7-25AccessChoiceCounseling.pdf

How many recipients have joined a plan since enrollment began?

2006-08-18T21:48:00.000-04:00

Since enrollment began July 24, 2006, more than 5,200 Medicaid recipients in Broward and Duval Counties have joined a plan.

Source: AHCA
http://www.fdhc.state.fl.us/Executive/Communications/Press_Releases/pdf/8-10PediatricAssociates_3.pdf

Welcome to the Florida Medicaid Reform Information Blog

2006-08-18T21:10:00.000-04:00

We are interested in hearing from Medicaid recipients in Broward County and Duval County Florida. How has Medicaid Reform affected you? What questions do you have?

Contact us at medicaidreform@pobox.com.

Medicaid Reform Advocates Coalition Blog

Medicaid Reform Beneficiaries Describe Glitches at Roundtable

Town Hall Meeting Near Tampa Highlights Concerns about Medicaid Reform Expansion

Georgetown Study Exposes Medicaid Reform Prescription Drug Problems

Nassau County Commissioners Continue Medicaid Reform Delay Effort

Report: Medicaid standards lacking

With disappointment, and continuing determination to help Floridians gain access to quality Health Care, I share the following findings of the Commonwealth Fund. The entire state-by-state rankings can be found at http://www.commonwealthfund.org/statescorecard.

Sincerely,

Dr. Marion D. Thorpe, Jr.

Florida Health Care ranks low

The high number of uninsured residents has been leading to poor-quality health care in Florida, a study reports.

Miami Herald, Herald.comPosted on Wednesday, June, 13, 2007BY JOHN DORSCHNERjdorschner@MiamiHerald.com

State rankings

The U.S. Health Care Front Line: Politics, Reform, and "Sicko"

Crist vetoes HMO increase bill and landlords bill

Dear Drs. Palamara and Ronik

The Medicaid Reform Disaster

Treatment worth time, money and action

Medicaid in the 21st Century

Documented denial

Report on Georgetown University Study of Medicaid Reform

Medicaid Reform Consumer Finds Obstacles on Way to Care

State budget includes Medicaid dollars for low-income hospital Patients

Florida Want Ads: Sound Health Care Leadership Needed ASAP!

Money Short For Hospitals, Poor

A Reality Check

Bay Area Would Feel The Appeal

Medicaid for Kids Under Fire

Medicaid Stories: A Front-Line View

And the Answer is... “I Don’t Know”

Strictly my Opinion

Video of Medicaid Reform Public Meeting

Powerpoint Explaining Medicaid Reform

Advocates want tax to fund health care

AHCA Responds to "False Medicaid Reform" Article

Letters: Medicaid reform having positive effects for patients

Medicaid dental program needs reasonable rates to draw dentists

Medicaid Spending Sees First Decline

Hope for millions without health coverage

Hope for millions without health coverage

Gov. rule change could be costly for thousands with chronic illnesses

What Kind Of Health Care System Do Floridians Want?

Medicaid Spending Rises Only Slightly

Medicaid and People with Developmental Disabilities - From the ARC of the United States

WellCare dominates Jacksonville Medicaid market

Medicaid Choice Counseling

Percent of Children (1-17) with Emotional, Developmental, or Behavioral Problems that Received Mental Health Care, 2003

Medicaid's Role for People with Disabilities

Experts Urge Lawmakers to Help Ease Growing Mental Health Crisis in Seniors

Report calls for outreach to uninsured Hispanics

South Florida Sun-Sentinel Editorial Board

New Requirements for Citizenship Documentation in Medicaid

The rising pharmaceutical expenditures for treatment of mental health disorders

The Medicaid Reform Advocates Coalition-Partial List

Government Report Finds Healthcare Privacy Breaches Rampant

Georgia Medicaid, PeachCare Beneficiaries To Enroll in HMOs Friday Despite Concerns

Early Experiences of Medicare Beneficiaries in Prescription Drug Plans

Sun Sentinel: Funding gap leaves thousands of severely disabled residents on waiting list

Study: Percentage of physicians not accepting new Medicaid patients rises

Resources on Medicaid Policy Changes -- Kaiser Commission on Medicaid and the Uninsured

Information About Evaluation of Medicaid Reform

Governor Bush's Comments on Medicaid Reform 12/10/05

FLORIDA MEDICAID REFORM - National Conference of State Legislatures

Washington Post Article on Medicaid Reform 6/12/06

Our Blog has an easier-to-remember address: www.floridamedicaidreform.org

Miami-Dade - Dental HMO flawed, study finds

Understanding Florida's Medicaid Reform

Enhanced Benefit Account Services Program - upcoming trainings

We are interested in hearing from Medicaid Recipients

South Florida Business Journal Article About Medicaid Reform 11/21/05

Article about Medicaid Reform by Andrew Leone of Florida CHAIN and Responses

Florida Medicaid Reform Choice Counseling How to Get Ready

Medicaid Reform and People with Disabilities - Comments of the Advocacy Center

Circle of One Marketing

Medicaid Reform Brochure from AHCA

Letter from AHCA to Medicaid Recipients

How to Reach a Choice Counselor

Information About Choice Counseling

How many recipients have joined a plan since enrollment began?

Welcome to the Florida Medicaid Reform Information Blog

Miami Herald, Herald.com
Posted on Wednesday, June, 13, 2007
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com