The Medicaid Reform Pilot program running in Broward County since 2006 has not improved or increased health care coverage, but has instead become a bureaucratic nightmare with lower costs because of reduced services. That was the consensus of speakers at a Tuesday evening workshop held in Hollywood and organized by Democratic state Rep. Elaine Schwartz.
The Pilot created a managed-care approach in which Medicaid recipients must choose an HMO or other care-management organization to access services. According to Rep. Joe Gibbons, D-Pembroke Park, this is a business model, not a patient-care model.
State Sen. Joe Negron, R-Palm City, has proposed a bill that would shift the bulk of Florida Medicaid patients into HMOs and other managed-care plans.
The managed-care approach is precisely what Broward residents said has not worked at Tuesday’s workshop.
“I am outraged that after five years Medicaid Reform has not improved care in Broward and we are talking about expansion statewide,” Dr. Alan Aaron Elkin, vice chairman of the OB/GYN department at Hollywood Memorial Hospital and chairman of the Broward County Medical Association, told participants.
In a March 2010 letter to Cindy Mann, director of the Center for Medicaid and State Operations, 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 pre-natal care for which timing is critical.”
Dr. Arthur Palamara, a vascular surgeon whose practice is located in Hollywood, said that poor patients who have chronic and/or acute health conditions that require complicated treatment find it difficult to navigate the Pilot program.
Several speakers told stories about patients or family members who were denied or received delayed coverage, even in the face of throat cancer and pituitary disease.
Palamara explained how one of his patients, who needed kidney dialysis, ended up in the emergency room, a common outcome due to a lack of coordination and the denial of services by managed-care companies.
Amy Silverman said she had to leave Broward County because of Medicaid Reform. “Since 2006 I had to choose between poorly managed HMOs,” she said.
Silverman said she couldn’t get access to mental health medications. Her doctors tried to get those medications, arguing they were life-saving, but she was denied.
Tracey Heldenmuth — director of Kidz Connection, which provides Medicaid patients with occupational, physical, and speech therapy — said Medicaid patients can’t opt-out, but are forced to choose a managed-care plan. She said that opting out is very difficult and involves too much paperwork and that up to 60 percent of her patients were denied services.
“I can come up with 150 Medicaid patients who have given up,” Heldenmuth said. “Extending this [Pilot program] is a kiss of death for children.”
Laura Goodhue of Florida CHAIN, which works on behalf of Medicaid patients and providers said, “In Tallahassee, you are often hearing one side of the story. Broward County constituents are saying this Pilot hasn’t worked.”
Goodhue said there is a way to deliver patient-centered care and save money, but not with legislation that supports capping the money that goes into Medicaid.
She said that after four and half years of the Pilot program, there is less choice in Broward because managed-care companies have dropped out.
Provider Service Networks — aka PSNs, a provider-managed, fee-for-service model — have also provided health services under the Medicaid Reform Pilot.
Joe Rogers — vice president of Broward Health, one of the 10 largest public health care systems in the nation and chair of the PSN Association of Florida — cited a University of Florida 2010 survey of 6,000 patients that showed that Provider Service Networks reduced costs, scored higher for customer satisfaction and ranked higher in quality measures and the stability of care.
Rogers indicated that as costs increased, HMOs left the market. He added that 40 percent of Broward County Medicaid recipients are in a Provider Service Network, and he warned that Negron’s proposed bill would force the networks to operate more like HMOs.
Michael Garner — CEO of the Florida Association of Health Plans, which supports the statewide shift to Medicaid managed care — said the state needs to limit growing costs and require patients to undergo less costly preventative measures rather than wait for more expensive emergency treatment.
Garner did not dispute any of the arguments against managed care. When asked how he would deal with issues of people not getting enough coverage under the managed-care model, he said each plan is limited to what is in the contracts.
Broward County Mayor Susan Gunzburger was less subtle: “We are not happy being the pilot for Medicaid reform.”