Medicaid Reform Beneficiaries Describe Glitches at Roundtable

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

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

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

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