Medicaid Reform: Yet Another Barrier To Care

By Toni Waters Woods

On Thanksgiving Day 2006, my father, James "Buzz" Waters, was waiting to be disenrolled from the Medicaid reform pilot program in Duval County so that a high-risk cardiologist in Alachua County would see him. Jacksonville cardiologists referred my father to the Alachua doctor because apparently there was not a high-risk cardiologist in the Duval County Medicaid reform program. This wait proved to be fatal.

Before Medicaid reform my father would have been able to immediately make an appointment and be seen by the cardiologist in Alachua county. Two years ago the state introduced a pilot program to North Florida and Broward county that required more Medicaid recipients to join Medicaid HMOs. Proponents of the pilot claimed that Medicaid Reform would result in increased choices of health plans and providers. But by forcing more Medicaid patients into Medicaid HMOs it has instead created new barriers to care. In fact patients are now unable to access specialists who accept Medicaid but are outside reform plan networks without experiencing unnecessary and sometimes fatal delays. Because the specialist my father needed to see was not part of Duval county's Medicaid reform network, he had to waste precious time going through the disenrollment process before he could even make an appointment with the out of network high risk cardiologist. New Medicaid plan enrollments only start at the beginning of the month. As a result, the time frame for effectuating disenrollment from a plan is a frustrating and ludicrous obstacle for high-risk patients who have immediate needs that cannot wait. My father didn't make it to December 1. He died on that Thanksgiving Day, November 23.

Examples like my father's highlight the problems with forcing more high-risk Medicaid patients into Medicaid HMOs. Which is why I'm concerned when I hear the state is considering expanding the pilot program to the entire state. Medicaid reform in the state of Florida is not working for many patients. "Reform" has not only failed to solve the old problems, but it's created a slew of new ones. The reform program’s limited provider networks puts people with complex illnesses at risk. There are many documented stories like my father's about patients stuck in a spiral of red tape and rules that have led to further medical complications. Reading these stories is heartbreaking at times. A letter sent last year to the Florida Medicaid director from Florida CHAIN and Florida Legal Services highlighted many of the problems patients were having. A woman with diabetes was denied coverage for her insulin, goes into diabetic shock and almost dies; a man with severe mental illness ended up in the hospital because of coverage denied for his medications; a child with disabilities was unable to access critical therapies because of a lack of providers.

There are many policy arguments on all sides of the Medicaid reform issue. But we should listen closest to those who must navigate the complex maze of rules that Medicaid reform has put into place: the patients.

In a report from the Agency on Health Care Administration, it says Medicaid reform "seeks to improve the value of the Medicaid delivery system." I do not believe that happened in my father's case and I do not believe that the value has been improved for many of Florida's citizens, whether patients or taxpayers.

Managed care companies require profits and increasing amounts of reimbursement from the state. These needs are difficult to reconcile with the health care needs of high-risk and very sick Medicaid patients. Notably, in recent months managed care companies threatened to leave the program but changed their minds only when the state gave in to their demands to reduce proposed cuts from 5 percent to 3 percent. Decent health care should be not be judged by the balance sheet, but by the health of its patients.

One step in the right direction would be to permit emergency disenrollment procedures for Medicaid patients needing to access care not available through reform plans. Those protections were not in place for my father. Florida certainly should seek greater choices, access and flexibility for its Medicaid patients, but it should do so by reworking the fatally flawed reform program first, not by expanding it.
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Woods is a resident of Duval County.
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