Florida Health News

Advocates to warn Medicaid patients of pending change

By Christine Jordan Sexton
5/13/2008 © Florida Health News 

TALLAHASSEE -- Some health care providers and advocates are mobilizing to warn mentally and physically disabled Medicaid clients about a new state requirement that could force them into HMOs. The change, tucked into the recently passed budget, affects those Medicaid recipients in 29 counties who rely on their primary care physician to manage their medical care, a program called “MediPass.” Currently patients can remain in MediPass year to year without asking, but under the new rules, if they don’t specifically request it at the right time, they will be switched to a controlled network plan, usually an HMO. 

Those who work with severely disabled patients say a sudden shift of caregivers or drugs could be harmful. “It’s just not the way to treat these folks,” said Bob Sharpe, president and CEO of the Florida Council for Community Mental Health. “It’s a vulnerable group that is cognitively less able to make that choice.” 

Budget cutters imposed the new rule to save money. The new requirement is expected to switch 27,000 Medicaid recipients out of MediPass and is expected to save the state a net $6 million in hospital costs in the coming year. The Agency for Health Care Administration (AHCA), Medicaid’s parent agency in Florida, is trying to figure out how it will enforce the requirement, said spokesman Fernando Senra. Although the rule is supposed to take effect Oct. 1, he said enforcement could be delayed. “All of this is very preliminary,” Senra said. “We are still early on in this and we will have to develop a plan on how this would work.” 

The new rule applies to beneficiaries in 29 counties that have two or more managed care plans, including Miami-Dade, Hillsborough, Pinellas and Orange. The new rule has no impact on Broward, Duval or other counties that have already been placed under Florida’s Medicaid reform experiment, since MediPass has already been eliminated as an option there.
 
Brenda Ruehl, an associate director for a Tampa-based independent living center for the disabled, Self-Reliance Inc., predicted that the new requirement will confuse her clients. “When they get into a program they think it’s theirs forever,” she said. She plans to include information on the new requirement in the center’s newsletter, since AHCA’s letters to Medicaid beneficiaries tend to be full of bureaucratic lingo. “It’s not easily understood and it’s not consumer-friendly,” Ruehl said.
 
Senra said AHCA has not yet determined how it will contact beneficiaries to tell them about the new requirement. 

If a substantial number of Medicaid beneficiaries end up being switched to Medicaid HMOs, advocates say, the rule change will have the same effect as if the Medicaid reform experiment had been expanded beyond its current locations – greater Fort Lauderdale and metro Jacksonville. House Speaker Marco Rubio, R-Miami, tried to expand the program during this spring’s session but the Senate defeated the effort. 

Social services advocate Karen Woodall says the new rule will make it easier for the state to do away with the MediPass program. “The effect of this is eventually to have everyone in HMOs,” she said. 

AHCA identified the counties affected by the new rule as: Brevard, Dade, Gadsden, Hardee, Hernando, Highlands, Hillsborough, Indian River, Jefferson, Lake, Lee, Leon, Liberty, Madison, Manatee, Martin, Monroe, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie, Volusia, and Wakulla. 

Editor Carol Gentry, Carol.Gentry@FloridaHealthNews.org, contributed to the reporting on this story.
Christine Jordan Sexton can be reached at cjordansexton@hotmail.com.