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In Escambia, Santa Rosa, Welfare Change May Be More Complicated
June 14, 2011
Pensacola resident Julia Pearsall says she knows glitches will happen as Florida transforms Medicaid into a mandatory managed-care program.
But Pearsall particularly worries about glitches in the Pensacola area — where, unlike most of the state, HMOs aren’t already serving Medicaid beneficiaries.
“What happens in the short run can be a matter of life and death to the recipients,” said Pearsall, who has long worked on social-service issues.
Pearsall and an estimated 125 other people turned out Monday for a public hearing to discuss the massive Medicaid overhaul that lawmakers passed last month. It was the first hearing outside Tallahassee, as the Agency for Health Care Administration barnstorms across the state to take public comments about the overhaul.
“I am their most accessible health care provider,” Kim Cadenhead, owner of Kim’s Family Pharmacy in Cantonment, said. “Mailorder pharmacies are not, and never can be, a good health care provider. Any managed care program that incentivies mail-order prescriptions will be detrimental to my patients and to my business.”
For an earlier NorthEscambia.com story and additional comments from area pharmacists, click here.
Many of the Pensacola concerns echoed those in a Tallahassee hearing Friday. The loudest came from community pharmacists worried that managed-care plans will shut them out of the Medicaid business.
But questions have long swirled about how the Medicaid overhaul will work in the Panhandle. Many Medicaid beneficiaries throughout the state already enroll in managed-care plans — either voluntarily or in a five-county pilot program — but not in most of the Panhandle.
The lack of managed-care plans in the region, however, could change. Jennifer Robertson, a lobbyist for WellCare Health Plans, said during the hearing that her company plans to enter the Pensacola market.
Charles Brewer, president of Health First Network, a 600-physician network that contracts with managed-care plans in the western Panhandle, said his company expects to work with WellCare.
Brewer said his network contracted with a WellCare subsidiary, Healthease, from 2004 to 2009. But he said state cuts in Medicaid payment rates to HMOs led both companies to pull out of the program in the Panhandle.
The Panhandle and rural areas could be a key issue during the next few years as the state tries to carry out the overhaul. As an indication of the concerns, lawmakers took steps to make it easier to move forward with mandatory managed care in Northwest Florida.
The overhaul carves the state into 11 regions, with managed-care plans competing for contracts in each region. Northwest Florida has two of the regions — one going from Escambia to Walton counties in the western Panhandle, and the other including 14 counties that go all the way east to Madison County.
The law calls for the state Agency for Health Care Administration to contract with two managed-care plans in each of the Northwest Florida regions. Each of the other regions throughout the state could have more managed-care plans, with a region including Miami-Dade and Monroe counties having as many as 10.
Also, each plan that wins a contract in a Northwest Florida region will be awarded a contract in another region as something of a bonus.
The Pensacola hearing is one of 11 that AHCA is holding over a week-long period, as it prepares to meet an Aug. 1 deadline for submitting details of the proposed overhaul to the federal government.
With Republican leaders looking for ways to hold down costs in the $20 billion Medicaid system, Gov. Rick Scott signed the overhaul into law June 2. If approved by federal officials, almost all Medicaid beneficiaries statewide would be required to enroll in managed-care plans by Oct. 1, 2014.
During Monday’s hearing, managed-care industry officials told the audience that the changes, in part, will lead to better care that will improve the health of beneficiaries.
“We’re not managed costs,” said William McHugh, president of Amerigroup Florida. “We’re managed care.”
Steve Snider, an official with Molina Healthcare, acknowledged that the change faces questions in the Panhandle. But he also said he thinks it is the best alternative.
“Please keep your minds open,” Snider said.
Other speakers, however, raised repeated concerns about how the overhaul would affect community pharmacies and seniors.
Mom-and-pop pharmacies worry they will get elbowed out of the Medicaid business by managed-care plans that will use mail-order prescriptions or divert patients to other pharmacies. A steady stream of pharmacy operators asked for help during the hearing.
“With unemployment and the economy the way it is, it seems illogical to put more stress on independent business,” said David Enfinger, of A&E Pharmacy in Pensacola.
But Michael Garner, president of the Florida Association of Health Plans, said the overhaul will allow patients to have choices about the best way to get prescriptions.
Some speakers also said they were worried about requiring Panhandle seniors to enroll in Medicaid managed-care plans. The state plans to start moving forward with that requirement in July 2012, making it the first part of the overhaul to take effect.
Jason Waddell, a Pensacola elder-law attorney, said state officials should look at whether such a requirement is even feasible in the Panhandle, instead of putting it in place statewide.
“There’s not been any data that shows this will work,” Waddell said.
Managed-care officials, however, contend the overhaul will lead to seniors getting care in their homes and communities instead of going into more costly nursing homes.
By Jim Saunders
The News Service of Florida
Comments
16 Responses to “In Escambia, Santa Rosa, Welfare Change May Be More Complicated”
I guess my bank analogy was not exactly the best; my point was that if the person providing the benefit placed strings on the benefit and the person receiving them accepted those strings, then that closes the deal. It was a referral to the borrower being a slave to the lender, but more broadly, the recipient of benefit and the provider of the benefit.
If it were just seniors and genuine people-in-need and not for the fraud I’d probably be a little more receptive to government-run programs. It just seems that many government programs have one thing in mind-to get the people addicted to the handout and buy power for the politicians.
Not all charitable institutions are faith-based; but there is a point, churches could be more involved-many are in big ways, too. I wonder if they/we could do more if we weren’t taxed so heavily for programs that seem to have no system of checks and balances?
SW….Your last message is a very sensible post.
I googled the question you asked and you are correct. Most seniors are on Medicare and not Medicaid but it is also true that approximately 23% * do receive Medicaid, a number that would certainly affect seniors.
Your next question is,for me, more problematic, since we *are* the state. In many,if not most, cases the same people who are drawing from services have, at another point in their lives, contributed to the state. From that perspective the folks on Medicaid have every right to a voice about how,when,where. To ignore that truth is to cheapen the people in our society who just don’t have much and may need assistance.It’s true that *someone* must decide when, how, where, how much will be paid out or in many cases,returned to the citizens. But that’s the crux,eh? I mean why are we all here (on this forum)?
We are here generally to discuss, debate, argue, rant…..about the issues of the day. Some of us agree with what the folks currently in power are doing. Some of us disagree. Regardless, we all have that right to determine in our own hearts what we think and to express that. I know you agree with that but the fact is, we will never have complete consensus on *any* issue, least of all what the state should do as far as helping or not helping folks.
Speaking to your comparison between borrowing from a bank and the state providing services for it’s people, well I just ain’t quick enough to keep up with your reasoning on that.
As for the state getting out of the welfare business, if we who identify ourselves as Christians had been meeting our obligations all along, welfare would never have been needed.
I’m not sure, so I’m asking a sincere question, here. Aren’t most seniors on Medicare and not Medicaid? If this is true, and I don’t know if it is, then how would this affect seniors?
Another question; if someone takes money from a governmental body for a service, isn’t it fair for that government to dictate how (or where) the money is going to be spent? In other words, if someone is on Medicaid (state run program), is it not reasonable for the state to dictate where one must go to receive that service? How would that be different than the AFDC or WIC program dictating what can be purchased? How is that different than borrowing money from a bank (or individual) and that entity wanting to know how that money is going to be spent or on what item? The borrower (or beneficiary in this case) becomes the slave to the lender (or provider), right? Why then, would the state not contract to a provider who would provide the service at the (theoretically) lowest cost, then have the recipients go to that provider?
If this is true, then that is the paradox of the system and is another reason the state should get out of the welfare business, right?
I’m just asking.
One difference, by the way, in this state system and the federal one is that the federal one is mandating that everyone become a part of it; the state one is for those who voluntarily participate.
Fl medicaid has had HMOs before does noone rember that Healthease isnt that what it was? It really wont matter why do people really act like it matters unless you have been part of this messed up system you dont understand it. People say its free and act like we are nothing when we are on it but want to talk about it like you really care well please dont act like you do .
Amen eab.
If it is permissible by the state constitution then it is okay; if it is not then challenge it in the courts-DUH!. That is what is going on at the Federal level. Plain and simple.
I am against socialism at every level. I support any movement that protects the US Constitution and the limits on the federal government. If President Obama is violating that, then the challenge is rightfully taken on. The courts can decide whether it stays or not. That’s the process is it not-state or federal?
Or is it not okay to challenge Dear Leader?
This is a direct assault on Florida Seniors. Seniors spend more in Florida than any other demographic. For decades Florida has been home to retirees. One doesn’t have to look far to see that is changing (google where to retire). Why then is the Govenor (and legislature) making the senior portion of this bill the first priority? They have referenced Arizona as how this will save money; however, Arizona didn’t have a waiver program yet. Florida has a waiver program. When you look at states like that you will see they DIDN’T save money. What you are seeing is a Governor and legislature who has sold out to the insurance industry.
SW said…”Socialism is socialism, regardless of who buys into it…right?” and “Like I said, what is prohibited by the US Constitution may be permissible by the state constitution. I don’t know. I haven’t checked.”
I said…Yep No matter who buys into it and our Republican legislature has bought into it. The point here (I’ll explain it to you) is the irony of the conservative shills in our country screaming socialist at Obama while doing the same kinds of things whenever they find some power. For example the Republican party and it’s new found love of balanced budgets. This is new since we have had a Democratic president.
And…if you think the main reason they are fighting Obama on health care is that it *may* be unconstitutional, then you haven’t been keeping up. The *weapon* they are using may be the courts but their goal is simply to get Obama out of office and undo anything he has done.Their motive is to cut out more dollars for insurance companies and their big campaign contributors.They have lied and will lie (birthers for example) to do so.
He gets castigated for doing some of the same things Republicans originally proposed or supported.
As for the governor, all he has to do is not sign the laws the legislature sends him.
Why is everyone yelling at the governor; why is no one yelling at the state legislators? This had to go through them first, right? The governor didn’t just dictate a law; it had to go through the process.
Seniors are who voted this guy in, now they are about to be forced into scotts healthcare plan without choice.
Where is the Tea Party screaming about this?
So it’s only socialist if it is signed into law by Gov Scott, but not by Pres Obama? Socialism is socialism, regardless of who buys into it…right?
Like I said, what is prohibited by the US Constitution may be permissible by the state constitution. I don’t know. I haven’t checked.
WHO is going to explain this new program to all of the Medicaid recipents? The uneducated, elderly residents in our area. How can they make an educated decision? HMO’s are BAD!!!!!!
So…are the people who have whined and screamed so loud about Obama’s health care plan gonna stand up and oppose this Socialist move by Rick Scott and his cronies or will they spend all their time explaining why this law is *different*?
Once the courts rule on the “Obamacare issue” we won’t know anything except that we’ll have to wait until some more courts rule.
Hold on a minute. The reason they are fighting Obama on the Obamacare issue is because it is, arguably, not a role of the federal government under the US Constitution (I personally believe it is not-we’ll soon know when the courts rule). It may or may not be under the FL state constitution (I don’t know-Google it).
Republican or Democrat makes no difference.
Yep, it is and they are still fighting Obama but its okay if a republicans creates it and makes it much worse by forcing people into an HMO that will be poorly paid. How does it save money to go through a contractor who has to make a profit? Is this a way to fatten more pockets at our expense? Got to love the republicans!!
“Some speakers also said they were worried about requiring Panhandle seniors to enroll in Medicaid managed-care plans. The state plans to start moving forward with that requirement in July 2012″
Forced healthcare plan, Doesnt that make Scott a Socialist? Isnt that what they were fighting Obama about? But yet they will do something similar? humm