As Florida waits for approval from the federal government before moving forward with its plans to overhaul Medicaid, patient advocates remain concerned about problems with prenatal care access that plagued a five-county pilot program similar to the new statewide measure.

One of the chief complaints about the state’s Medicaid Reform Pilot, which went live in five Florida counties in 2006, was that patients struggled to find proper access to prenatal care. There were rampant reports of pregnant women receiving delayed care or even being removed from their plans.

Independent research shows that since the implementation of Medicaid Reform Pilot in those select counties, the problem with prenatal access remains.

Anne Swerlick from Florida Legal Services says that “some really troubling measures have come out of those reports.” She confirms that “access issues” for prenatal care remain, on the whole, unsolved.

Research conducted by the Health Services Advisory Group released in December 2009 shows that the time a women enrolled in the Medicaid Reform Pilot waits to see a doctor once she learns she is pregnant was not decreasing. According to the data, the “timeliness” of prenatal care shows “room for improvement, with a majority of the plans reporting rates below the low performance level (LPL).” The group advised that “managed care organizations (MCOs) should specifically target prenatal care [and] cervical cancer screening … for either a future performance improvement projects or focused improvement efforts.”

The next year, the group’s research showed that the same problems persisted: Pregnant women were waiting a long time before going to see a doctor and were getting kicked off plans once they did begin receiving care.

Dr. Aaron Elkin, a board-certified obstetrician and gynecologist, sent a letter to the U.S. Department of Health and Human Services warning the federal government about the state of prenatal care in the Medicaid Reform Pilot in March 2010.

Elkin wrote:

Since Medicaid Reform was implemented in Broward County in 2006, a large number of my Medicaid patients have experienced significantly greater difficulties in accessing timely and quality care, including prenatal care for which timing is crucial.

Since Medicaid Reform, I rarely see pregnant Medicaid patients who are in a reform plan in the first trimester of pregnancy, which is the best time to initiate pre-natal care and ensure the best possible outcomes for both the mother and child. Most of my Medicaid patients that are trying to see me fore obstetrical services are not able to see me until midway or later into their second trimester.

From my experience and observations regarding Medicaid Reform: there is decreased access to care, inaccurate information provided, higher costs, poorer care, fewer services, more forms, less satisfaction and no informed choice.

The state is now awaiting federal approval for its overhaul of Medicaid, which moves all Florida Medicaid beneficiaries into managed care programs. Elkin tells the Independent that as the state’s plan stands, “access to care will decrease and patient satisfaction will decrease.”

Judi Vitucci, president of the Florida Association of Healthy Start Coalitions, says her organization was “very concerned with the access to prenatal care in the Reform Pilot.” She says the group “has been successful” in getting the Legislature to allow Healthy Start to help solve the problem.

The Legislature wrote a provision that directs pregnant women to Healthy Start when seeking prenatal care. Healthy Start will then assist women in finding their doctors and make sure women are receiving the care they need. The program is funded through Healthy Start’s MomCare program.

Vitucci says that “managed care programs will be required to work with Healthy Start.”

The effectiveness of the program will depend on whether the organization can afford to provide the services. As of now, Vitucci says Healthy Start is set to receive payments through MomCare, but the system is untested. According to Vitucci, it is the most significant effort yet to address the issue of prenatal care in its Medicaid plan. Vitucci says that Healthy Start worked with legislators to include the provision.

“Time will tell,” Vitucci says. “If the funding is low, we won’t be able to stay in business.”

Providers in the Medicaid Reform Pilot have left the system due to the program’s low reimbursement rates. Vitucci says that if the reimbursement rates are unsustainable for Healthy Start as well, there is no telling whether the organization will be able to continue to assist Medicaid beneficiaries.

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