Florida Seeks Changes In Medically Needy Program

May 9, 2012

Florida Medicaid officials have asked the federal government to approve major changes in a program that serves tens of thousands of people with costly medical conditions, seeking to install a type of managed care and require monthly premium payments.

The Agency for Health Care Administration, carrying out a 2011 law, requested changes in the state’s Medically Needy program. In a document sent to the federal government in late April, the agency said the proposed changes would improve care for beneficiaries.

“The proposed demonstration (the changes) will improve the effectiveness of the Medically Needy program by providing access for this population to an integrated service-delivery system of health care,” the document said.

But Florida CHAIN, a patients-advocacy group, blasted the proposal. It said, in part, that most Medically Needy patients would not be able to “remotely” afford monthly premiums that are part of the plan.

The Medically Needy program, which the agency says will cost about $1 billion this fiscal year, serves people who have often-debilitating conditions but don’t qualify for the regular Medicaid program because of their income levels. On average, more than 48,000 people are enrolled in the program each month, and it serves a combined total of 250,000 people a year, according to the document submitted to the federal government.

Some lawmakers have repeatedly argued in the past for scaling back the program — but the idea has met with fierce opposition from advocacy groups and hospitals, which provide much of the care to the patients. Among the most outspoken opponents during legislative debates have been organ-transplant recipients.

Lawmakers in 2011 approved a massive overhaul of the Medicaid system that included changes in the Medically Needy program. AHCA on April 26 sent a request to the federal Centers for Medicare & Medicaid Services for what is known as a “waiver” amendment that would carry out the changes.

The proposal would require Medically Needy beneficiaries to enroll in a statewide provider-service network, a type of managed care that would be responsible for trying to better coordinate services that patients receive. Eventually, the beneficiaries would transition into a broader statewide managed-care system that is the key part of the 2011 law.

The Medically Needy program uses a complicated process in which patients have to qualify each month based on the amount of medical bills they rack up and their income levels. Under the proposed changes, they would continue to qualify for the first month of coverage in that way and then would move into the provider-service network.

In the request to the federal government, AHCA touted that the proposal would allow Medically Needy patients to stay in the program for up to six months without having to qualify each month. It said, in part, that such a change would improve care and remove an incentive for Medically Needy patients to incur medical bills to meet monthly qualification requirements.

“Recipients (would) have access to care coordination, and the incentive is removed for the emergency room to be the first choice of setting for medical care in order to qualify for eligibility,” the document said.

But the proposal also includes a new premium requirement that Florida CHAIN contends would force Medically Needy beneficiaries to pick up a larger share of their medical costs than under the current system and could be unaffordable for many. The amount of premiums would vary, based on factors such as income levels and family sizes.

The proposal, however, includes a “grace period” that would allow people to stay in the program for 90 days before they would be forced out because of non-payment of premiums.

AHCA needs approval from the Centers for Medicare & Medicaid Services before it can move forward with the changes, as Medicaid is governed by federal law and is heavily funded by the federal government. Shelisha Coleman, an AHCA spokeswoman, said in an e-mail Tuesday that the federal agency is not required to respond to the request by a certain time.

By The News Service of Florida

Comments

2 Responses to “Florida Seeks Changes In Medically Needy Program”

  1. Mae on May 10th, 2012 9:20 am

    It’s called Medically Needy for a reason! On the flip side you’ll have more people abusing this program by not having to re-register every month. Also if anyone reading this, just an FYI the monthly deductible that has to be meat is outrageous. Example a family of two, with a monthly income of about $850 a month some have to pay out a minimum of $300 before their medical share of cost Medicaid kicks in, and you want them to pay premiums too? (This was my experience last year). I know there are several types of Medicaid out there and that nothing is paid out of pocket with straight Medicaid. My point is if the out of pocket expense is unaffordable with share of cost Medicaid, if your poor enough to qualify for straight Medicaid, you more than likely can’t afford to pay the premiums! I know I couldn’t!
    As far as Donna’s comment…seriously? Think about it, the data collected from welfare recipients from last year’s testing showed only about 2% of recipients failed, same as in the work place. Drug testing is a waste of my tax money! We spent a few million dollars statewide last year to save payments a few hundred thousand dollars to the 2% that tested positive. As far as an on-site lab do you have any clue what that would cost? That requires state certifications, and licenses, and employing several people that are trained to perform the tests per county times the 67 counties in Florida. (There’s a few million dollars more for the state to waste.) I was on state assistance last year, for a few months, and with the new structuring guidelines for all the hoops you have to jump through, most addicts don’t stay in the cash assistance past 2-3 days! Thankfully I am gainfully employed and don’t have to worry about state programs last year. I HAD TATTOO’s PRIOR TO BEING ON WELARE (I also have a college degree, so don’t stereotype!)

  2. Donna on May 9th, 2012 9:27 am

    I think a small fee for those on Medicaid or programs similiar. A LOT of the people who are receiving these benefits have money to buy cigarettes, beer and expensive tattos all over their body. So $10 – $20 month is reasonable. Also believe random drug testing would also be a great idea You can do the onsite ones, not as costly as labs, but it would help eliminate some who are abusing the system. Trying to help cut costs so that those who really need help are able to receive it.

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