Medicaid town hall in Jacksonville reveals lingering concerns with Reform Pilot program

Tuesday morning’s Medicaid town hall held at Jacksonville’s Department of Children and Families went fairly smoothly, considering how heated the issue of overhauling Medicaid has become. Florida’s five-year Medicaid Reform Pilot program, which was implemented in four Northeast Florida counties and one in South Florida, was intended as a cost-saving experiment — one that critics say has reduced the quality of care for the disabled and indigent.

The pilot program involved turning the majority of program recipients over to for-profit HMOs as a replacement for the traditional fee-for-service model (in which doctors and pharmacies are reimbursed for every procedure or drug provided to Medicaid patients). The program required the majority of patients to sign up for a private HMO or other provider-service network set up by hospitals and doctors.

The state Legislature this year passed a law that will expand the program statewide, a decision which raises dozens of questions on the part of critics and patients alike.

State Rep. Mia Jones, D-Jacksonville, said that comments made in today’s town hall would play a pivotal role in whether the federal government eventually approves Florida’s plan, since the majority of the counties included in the pilot program are located in the greater Jacksonville area.

The town hall included about 20 minutes of generic information on the program and nearly two and a half hours worth of public comments — from advocates, doctors, lawyers and Medicaid patients.

“I haven’t been able to find a provider that’s willing to accept either of the HMOs,” said Linda Pierce, a Clay County resident who receives Supplemental Security Income and is on Medicaid. “I’m currently without a primary care physician, running a wild goose chase.”

Pierce told those gathered that she was concerned about finding out the history of a doctor prior to seeing them.

“I had a surgeon recently that was horrendous … [but] there was no way to find out the medical background of the doctor,” she said. “He released me straight from surgery, but gave no pain medication, because, he said, ‘My license doesn’t allow me to give those types of medications; you’ll have to go to your primary care physician.’ … I’m kind of at a loss about my personal issues.”

Several elder law attorneys were also on hand to discuss their take on the Medicaid Reform Pilot. Each spoke similarly, arguing that the data to support continuing the Pilot wasn’t persuasive.

“No seniors were ever a part of the initial program, so there’s no way to know if they would benefit from this,” said attorney Robert Morgan. “Arizona tried a very similar program. … Two decades later, they’re still trying to get out of the hole they got in to. We don’t want to be there.”

The program would move elderly patients from nursing homes to in-home care, which many would likely prefer — initially.

Elder law attorney Vicki Bowers argued that forced managed care could have a snowball effect. “In many cases, the elderly would be moved from nursing homes into a back bedroom of their adult child’s house,” she said, adding that, left unattended, they’d be more apt to fall or take medications incorrectly.

Many of the attorneys in the room agreed that nursing homes might not be the most enticing option — but, because of 24-hour supervision, they are preferred.

Another Medicaid patient, German Vivas, described himself as former school teacher and IRS employee, and a kidney transplant survivor. He said he felt anxiety upon hearing of potential changes to Medicaid.

According to Vivas, while working in North Carolina as a teacher, he lost his health insurance. That experience, coupled with the kidney transplant, led him to a life motto of sorts: “I know what it is to die.” And while Vivas is quick to thank the state of Florida for his kidney transplant, he is still worried about the future of the state Medicaid plan: ”I am very grateful to the state of Florida for saving my life, but I happen to like staying alive. I know what it is to die, and I also know what it is to live.”

State Rep. Jones, the ranking Democrat of the House Health and Human Services Committee, said she was in Washington recently, to speak with legislators, including Rep. Corrine Brown, about the Medicaid program. In a statement made in March, Jones said that the state’s Medicaid overhaul was “based on scant data from a failed Medicaid experiment that should not be expanded statewide.” Florida currently has nearly 3 million Medicaid patients.