Florida Medicaid & Private Insurance Companies

This section of the article discusses how the Florida Medicaid reform has had a severe impact on the medical care of those on Medicaid. Many patients have been switched from one insurance provider to another and are not receiving quality health care as a result.

Read Part 1: Florida Medicaid: Expanding Privatization

Read Part 3: Florida Medicaid: Patient Survey HMO Wellcare Abuse

For many poor Americans who are seeking health care, Florida Medicaid has been a last resort. The program works as a partnership between states in the country and the federal government. Of the Florida Medicaid costs for the next year, the federal government will cover 56% of all costs and the taxpayers will pay the remaining amount. The budget of Medicaid has been increasing over the years due to rising health care costs and by the end of this year, it is believed that 1.1 million new Florida residents will have signed up for Medicaid, an increase of 51 percent from 2007.

Jeb Bush is responsible for privatizing the Florida Medicaid program. This idea was approved by the federal government and the government actually helped to steer the program through the Legislature in 2005. Bush argued that if private insurance companies were able to compete for Medicaid patients, health care options would be expanded and costs would be limited. The whole idea is for the state to save money by making payments to HMOs in a lump sum for the cost of patient care instead of paying for individual doctor and hospital procedures.

The reform first began in 2006 when a test program was initiated in Fort Lauderdale and Jacksonville. The program later expanded to three other regions of Florida. There is equivocal evidence that the model will work across the state.

Critics of the pilot program are concerned that the HMOs would deny services in order to keep their profit margins high. Doctors and some insurance companies may be reluctant to participate based on results from the test program.

From the beginning of the pilot, insurance companies constantly struggled to handle new customers and made complaints that the state was not paying enough money for each patient. There were many insurance companies that dropped out as a result. Out of the original 17 insurance companies, only seven of them remain.

This caused many problems because as these companies withdrew, patients were transferred to other insurance providers and in the transition, treatments lapsed. According to the past president of the Broward County Medical Association, Arthur Palamara states that the program created "barriers against patients getting proper care."

Based on a study conducted by Georgetown University's Health Policy Institute, almost half of all doctors that were surveyed in the pilot area believed that the reform had damaged Florida Medicaid. A mere 8 percent of doctors though the reform was a positive thing. Many doctors do not accept Medicaid because of the low payments, but in counties with the reform pilot, the problem got worse. More than 25 percent of the doctors left Medicaid.

Problems among physicians became worse as well and more than half reported that it became even more difficult to receive payment and 62 percent of them said it was nearly impossible to get the insurance companies to authorize treatments.

Of 276 physicians that were surveyed, 2/3 agreed that their patients were having difficulties getting necessary treatments because the plan limited their benefits or did not receive prior authorizations for treatments. Howard Mellinger, a resident of Sunrise, has spent many hours battling with the HMOs that covered his son, a bipolar schizophrenic living in a Fort Lauderdale group home. He claimed his son went between four different HMOs, one of which was very slow to approve the anti-psychotic medications his son needed. His son was also hospitalized three times within five weeks and was involuntarily committed to a psychological treatment program because he was exhibiting delusional behavior caused by prescription lapses.

The health care companies that are treating Florida Medicaid patients report similar stories. Janet Horn, a director of a day care center for medically fragile children reported that the HMOs were pushing for the families to care for the children at home and place them in public schools. Horn stated, "They try to shift the cost onto the public school system, but the kids often come back here because the schools can't handle them; they're too medically complex."

Rosenstock became a critic of Medicaid reform when she was struggling with insurance companies to get medications for her son. Her son was dropped by two HMOs over the past two years and has had difficulty obtaining expensive prescriptions for testosterone and human growth hormone. He suffered through long stretches with no medication. Rosenstock said, "They were denying his medications and his life was in jeopardy."
by Dave Henderson (Medicaid Consultant: Sarasota, FL)

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