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Questions on Florida Medicaid Reform from Personal Knowledge

Being the mother of a chronically ill 39 year-old-son with MS who became ill 3 years ago with no insurance, it has become my life's goal to try to bring quality of life issues to the forefront for all chronically ill patients in the U.S.A.. I am currently enrolled in a doctorate program where I will be writing a dissertation on the lack of quality care for adults who are enrolled in the Medicaid program.  Because of this I have been doing some intensive research into the new proposed Medicaid program that Former Governor Jeb Bush had proposed in Florida.  This has been espoused to become a model for the entire country, but one that has been very lacking and appears to have some serious flaws as reported by many journalist and Georgetown University.

Florida Medicaid Reform Document

http://www.mffh.org/FL_MedicaidReformFactSheet.pdf

Florida Medicaid serves just over 2 million individuals. Currently, the Florida Medicaid program has agreements with over 80,000 providers. There are over 47 different categories of Medicaid services and more that 140 million individual claims are processed each year. Florida has the fourth largest Medicaid program in the nation in terms of monthly enrollment, which in June 2004 was 2.09 million individuals, and the fifth largest in terms of total annual expenditures (over $12.8 billion in 2004).1 The Florida Agency for Health Care Administration (AHCA), which administers the Medicaid program, projected spending of $14.7 billion in 2005.2 If these trends continue, by 2015 AHCA projects that Medicaid would represent 59 percent of the state's total budget with expenditures over $50 billion dollars. Actual caseload in December 2006 was over 2.1 million recipients. The Medicaid budget for 2006-2007 is $15.9 billion and the projection for 2007-2008 spending is $16.1 billion.

Recently I had interviewed a very strategic person in one of the main HMO insurance companies that will be gaining from this proposed plan.  One of the things I found out was that each person is given the yearly "stipend" based on their age, not on their condition.  He agreed with me that this is not a very good way to gauge the amount that will be needed for chronically ill patients.  He also said that there are no catastrophic care stipulations in the proposed program, but he felt that the State would not refuse to help someone that would need more money for the yearly care.  That is a very important issue to me.  I told him that this issue needs to be discussed more and worked out! 

I was also told that physicians who accepted Medicaid were paid .36 on the dollar as compared to their ordinary costs.  This of course tells us why there are so few qualified Dr.'s and specialist in the Medicaid support.  He shared with me that there is a new head of the Medicaid Dept. in Tallahasee, who said he feels that there is a real deficit in the area of specialists to support patients who have to use Medicaid.  I see this as a major issue if and when the blanket insurance plan is developed by the next Presidential Administration.

Another important issue is the lack of paying the physicians on time.  I was informed by this person that the $308 million dollar EDS contract that Florida had given to the Ross Perot Texas oversight company where the money goes right into the AHCA funds, http://www.eds.com/news/releases/3022/ so it looks like this isn't going to help in paying the Dr.'s on time.   

I found this article written May 9, 2007 By Urvaksh Karkaria, The Times-Union Jacksonville concerning these issues:

Study: State Medicaid reform pilot falls short Beneficiaries and doctors say the program is more complex, a Georgetown survey says.

http://www.jacksonville.com/tu-online/stories/050907/bus_168514889.shtml

Several beneficiaries, especially those with disabilities and chronic health conditions, cited problems in finding a plan that would allow them to keep their doctors, according to the study. Most recipients reported frustration with the complexity of plan choices and differing benefits packages. Medicaid reform also appears to be shrinking the already limited roster of doctors who accept the government insurance. Twenty-seven percent of 141 responding doctors who took Medicaid pre-reform, said they did not intend to participate in the reform plans. Of those, about two-thirds were specialists. One of Medicaid reform's goals was to increase access to specialists, said Lori Bilello, executive director of the Jacksonville-based Health Planning Council of North Florida, a health policy research agency. "It's clear," Bilello said, "that the specialists don't think having the same reimbursement rates, and lot more paperwork, and lot more hoops to jump [through], is worth staying in Medicaid."

My son and many patients like him are going to find themselves in 2008 faced with the reality of this very flawed system.  There are very few people involved in the advocacy of finding a better way to reach the best solution and highest quality standards that can be gained for the chronically ill lower income adult patients.  My son almost lost his life over incompetent care that he received from uninformed neurologists who would not take the diagnosis that was given by a very competent MS specialist who is on the Board of Directors of the Orlando, Florida MS society simply because he was not a member of the Medicaid insurance plan they were on. 

I would like to see the Society's like the MS Society, Cancer Society and others give more help to the patients and stop paying such high payments for the Administration of these socieities.  I would also like to see the University Medical Centers, where my son finally got the care he needed that has kept him out of the hospital for a year now, work closely with the socieities to become premiere health care initial diagnosis centers where patients can then work with local specialists to form a quality of care regiment. 

To the world you may be one person,
but to one person you may be the world.