Medicaid Archives - Page 3 of 32 - Florida Politics

CNN reports, eloquently, on the nightmare that is Florida Medicaid

It’s been ten years, almost to the day, since Congressman-elect Charlie Crist pulled $360 out of his pocket to pay for a year’s supply of thermal blankets for 12-year-old Kevin Estinfil, and pulled the plug on state lawyers who’d been fighting in the Third District Court of Appeal to deny the boy the basic supplies that were keeping him alive.

Back then, Crist was the Florida Attorney General who had just been elected Governor, and Kevin was confined to a Medicaid group home for children with life-threatening medical conditions. Kevin’s case turned up on Crist’s radar thanks to bad publicity courtesy of Miami Herald reporter Carol Marbin Miller, but not before the state had spent enough money jerking Kevin’s caregivers around to pay for a warehouse full of thermal blankets.

Today, half of Florida’s children rely on Medicaid “insurance,” and the plan is managed as badly now as it was a decade ago.

People who study Medicaid for a living will not be surprised by anything in the damning new report from CNN Senior Medical Correspondent Elizabeth Cohen, and neither will families who have sacrificed their savings, their careers, and any hope of a normal life for the sake of a child who will never be able to care for himself.

For the rest of us, Cohen’s look into the lives of Florida’s “health care refugees” is a bone-chilling holiday buzzkill.

Among the refugees are Kim and Richard Muszynski, formerly of Boynton Beach. With good jobs and longtime Florida roots on both sides of their blended family, they could not have imagined packing it in and starting over in Colorado.

But that’s what they did, after five-year-old daughter Abby, who was born with a life-threatening genetic disorder, had one near-death experience too many due to the toxic combination of underfunding and red tape for which Florida’s Medicaid program is infamous.

In Colorado, Abby’s physical health and her parents’ mental health have improved dramatically. Somehow, America’s Centennial State has figured out how to give children enrolled in its Medicaid program the therapies and medications ordered by doctors, without interference from Dr. No at the Department of Pennywise, Pound Foolish.

Another member of the Florida Medicaid Diaspora is three-year-old Sofia Patriarca. Like Abby, her needs are complex and will require round-the-clock care all her life. Sofia’s parents sold their family pizzeria in Lantana and will relocate to a state that’s safer for children with unique abilities.

“Medicaid forces us to give our children subpar care,” Sofia’s mother, Stefany Garcia-Patriarca, told CNN. “They treat them like animals instead of children.”

It took special courage for Heather Rosenberg to tell CNN that she and her husband have considered leaving Florida to obtain better health care for their children. As foster parents to 16 children, three of whom they adopted, Rosenberg is an expert on Florida Medicaid.

She described it to CNN as “horrible” and “an absolute nightmare,” hastening to that she speaks as a mother, and not in her role as — wait for it — children’s ombudsman at the Florida Department of Children and Families.

Florida spends a small fortune recruiting foster and adoptive families, and promises that they will not have to dip into their own pockets to fund essential medical services that are beyond the reach of all but families with the richest private insurance plans.

No matter how much room people like the Rosenbergs have in their hearts, they’ve only got 24 hours in a day, and they should not have to spend a minute of it begging the state to keep its promises to Florida’s Medicaid eligible children.

Marco Rubio promises to push for Medicare reimbursement increases for Puerto Rico

U.S. Sen. Marco Rubio promised Wednesday he will push for increased doctor reimbursements for Medicaid and Medicare as part of a package to bring Puerto Rico’s federal benefits in line with states.

Rubio, a Republican member of the bi-partisan, bi-cameral Congressional Task Force on Puerto Rico Economic Growth, met with an invited group of 20 Florida-resident Puerto Rican business and political leaders gathered in Orlando to seek suggestions on what the task force should push for from the federal commission overseeing the restricting of the territory’s finances.

There, Rubio promised to back those reforms and others, including tax credits to assist the people on the island in dealing with the economic crunch that is near bankrupting the government, straining services and decimating health care options as doctors flee the island. But he did not agree with everything suggested, notably as he defended keeping the 96-year-old Jones Act that regulates shipping to and from the island.

“I’m very confident that is going to be one of the recommendations that we’ll offer,” Rubio said of increasing Medicare payments to doctors so they can be encouraged, first, to serve Medicare patients, and second, to not flee the island seeking more money. “And I am hopeful it will make it into the task force’s document.”

The roundtable-style meeting, which featured Republican state Reps. David Santiago, Rene Plasencia, and Bob Cortes, a few representatives of Puerto Rican chambers of commerce and bar associations, and a few other business groups, and former U.S. Surgeon General Antonia Coello Novello, was officially a congressional meeting, not a campaign event.

Rubio is seeking re-election against U.S. Rep. Patrick Murphy of West Palm Beach. And he later acknowledged the importance of the Puerto Rican vote for him, or Murphy, to win Florida. And Rubio contended that he’s worked for six years on Puerto Rican issues, accusing Murphy of “just discovering Puerto Rico three weeks ago.”

Rubio offered no talk of financial bailouts and promised no deals that would put Puerto Rico’s government and people ahead of stateside investors when it comes to getting paid.

Instead, Rubio said the goal is to remove as many federal impediments as possible to open the island up for business investment, which he said is key to expanding the economy, wages, and taxes to fund the government.

“What can we do, what changes can be made in the federal government, to make the island a magnet for investment?” Rubio inquired.

He also said that ultimately Puerto Rico’s long-term status — remaining a U.S. territory, becoming a state, or becoming an independent country — must be decided as soon as possible, before it can offer the long-term sense of stability investors are looking for.

The task force Rubio was appointed to — along with Florida’s Democratic U.S. Sen. Bill Nelson — is to make recommendations by mid-December to the Puerto Rico Oversight Board, a board created by Congress this past summer that will act as executor in restructuring the island government’s debt and finances.

Rubio said many Republicans have been opposed to increasing payments to the island because they are fiscal costs to the federal government. But he said they must understand hundreds of thousands of people are fleeing the island for Florida and elsewhere to seek better health care and services, and in particular there is a brain drain of doctors and other professionals, so those fiscal costs would not be new, just moved from the states, if they can entice people to stay.

“It’s OK if people want to move. It’s not OK if people have to move,” Rubio said.

 

 

Case managers sue Sunshine Health for unpaid overtime

A Medicaid managed-care case manager is suing her employer, a state of Florida contractor, for unpaid overtime — one of many similar suits filed around the country against the company’s corporate parent.

Shanna Veit filed her proposed collective- and class-action suit in Leon County Circuit Civil court against Sunshine State Health Plan, seeking an unspecified amount of “unpaid overtime wages,” her complaint said.

The state contracts with the health plan to manage benefits under Medicaid, the joint state-federal health care program for the poor.

Sunshine Health is wholly owned by Centene Management Co., which specializes in health care for the underinsured and uninsured.

Centene has faced numerous lawsuits in several states involving allegations of unpaid overtime.

In June, the company “reached a $4.5 million settlement with a group of nurses who accused the health care company of failing to pay them millions of dollars in overtime,” Law360 reported.

Centene had said the nurses — who worked in California, Illinois, Missouri and Ohio — “were exempt from overtime requirements” under the federal Fair Labor Standards Act (FLSA), according to the site.

In July, the 5th U.S. Circuit Court of Appeals upheld a summary judgment against the company in a Texas case brought by former case managers and nurses. The court agreed the workers didn’t fall under the FLSA’s overtime exemptions.

Case managers like Veit developed care plans, assisted with referrals and helped resolve complaints, the suit said. She and others like her were “required … to work long hours and on weekends, including overtime hours,” for which they weren’t paid, her suit said.

Court dockets show 10 other case managers have “opted in” to join the action. Requests for comment were left with Sunshine Health’s and Centene’s corporate communications teams Wednesday afternoon.

Veit is represented by Tallahassee attorneys Sean Culliton and John C. Davis, and Pensacola attorney Jeremiah Talbott.

Jennifer Ungru: Funding for hospitals serving low-income patients presents challenges, opportunities

Three little letters — L-I-P — can spell panic in the hearts and minds of many hospital officials, as revenue estimators are forecasting a lean budget year for 2017.

LIP or the Low Income Pool is a combination of state and federal funding that helps supplement Medicaid payments hospitals receive. The funding comes from local tax dollars matched with federal Medicaid funds.

The LIP program was designed to ensure a significant return on investment for the local contributors because the local dollars invested in this program supporting Medicaid are optional.

Additionally, the program allows for a significant return on investment for the local tax districts that choose to invest in these programs in their communities and contribute the money on behalf of a named hospital.

Here’s how it works: Local tax districts contribute the money on behalf of a named hospital, the local dollars then draw down federal dollars where the combined amount is large enough to be worthwhile for participation in the program, as well as creating a remaining “pool” to be divided among other low-income-serving health care providers.

 This “guaranteed return” allowed for named hospitals to increase their Medicaid rates as well as “buy back” past legislative cuts to Medicaid hospital rates — a practice others who rely on state dollars to support their programs and services only dream about.

The remaining “pool” would be divided among the other providers based on a legislative formula agreed to by the federal government.

At the height of the program, these combined dollars accounted for nearly $2 billion in health care funding, or roughly 15 percent of total hospital Medicaid reimbursement. Since the overall health care budget is so large, this number needs to be put into perspective. Consider, outside of stand-alone children’s hospitals, Medicaid, on average, is only about 20 percent of a hospital’s overall payments.

Unfortunately, like all good things, Florida’s LIP program has an expiration date. In 2015, the Obama administration announced the program would be phased out within two years. For 2016/2017 the traditional $1 billion LIP program, the “pool,” was limited to approximately $680 million and the corresponding $800-900 million hospital rate enhancement investment was eliminated altogether.

Not only were the dollars limited, even the structure of the pool was dramatically changed, leaving questions as to whether local hospitals will even participate in this final year of the program.

Next year, the federal government will remove its remaining $400 million from the program. While local shares of the initial and current program still exist, those entities will have to determine how to best use those dollars.

Leaving state budgeters with the question of what to do next. Removing almost $2 billion within the health care system across the state in a period of two years is a lot, no matter where you stand on the issue.

The state has three options: do nothing and the program ceases, attempt the funding status quo and use general revenue to pick up the federal share, or try something new. As explained below, each option presents challenges and opportunities for our state policymakers.

— Do nothing. Local governments can decide what to do with the local tax dollars they’re collecting. Two years ago, local governments submitted $760 million to LIP, and this year, locals may contribute up to $272 million to the pool. This is a lot of money that can make a dramatic difference in local communities. Local governments could continue to collect the same tax dollars but reinvest them in ways to support local health care needs, or even return the dollars back to the taxpayer. Doing nothing, some would argue, levels the playing field. Unlike other programs that rely on state funding, hospitals have uniquely been able to “buy back” past budget cuts. Doing nothing would force hospitals to realize a true cut as other worthwhile programs have faced during lean times.

— Use state revenue to fill the hole. Remember Special Session 2015? For 2015-2016 budget, the Legislature provided an additional $400 million for hospitals within the Medicaid budget to soften the impact of the phasing out of the program. Lawmakers could provide a similar increase again. Because these dollars are designated for those hospitals that serve a larger portion of lower-income Floridians, some argue these supplemental payments actually keep the cost of health care down and avoid shifting the cost to privately insured customers.

— Finally, the Legislature could do something new, be bold and try to shake up the way of thinking in health care. To change behavior, the state needs to change the motivation. One option would be to build an incentive structure with local and state matched dollars focused on rewarding programs that actually lower the cost of health care. Instead of just bailing out the hospitals and increasing rates, why not set up a system where the state will match the local contribution when an ER diversion programs actually show true cost savings to the state. Emergency departments are the most expensive settings for care. If hospitals are truly committed to ER diversion, then why are wait times advertised regularly and off-site ERs are being built more rapidly than Starbucks? To make this work, the savings would have to be actual savings to the state, not just cost avoidance. While everyone talks about the rise in health care costs, we haven’t given a great look toward rewarding efforts that truly lowers the costs for Floridians. It is an idea worth lawmakers taking a look.

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Jennifer Ungru is a corporate affairs adviser in Jones Walker LLP’s Tallahassee office. Before joining Jones Walker, Ungru served as the chief of staff for the Agency for Health Care Administration (AHCA), which oversees the state’s Medicaid program and regulates more than 45,000 health care facilities. During her tenure, the agency implemented major health reforms, including the movement to Statewide Medicaid Managed Care, the largest procurement in state history.

Personnel Note: Beth Kidder named interim deputy secretary for Medicaid

beth-kidder-head-shot-2015Beth Kidder is Florida’s new interim deputy secretary for Medicaid, overseeing the state’s nearly $26 billion state program that pays health costs for the poor.

Christine Sexton of POLITICO Florida reports the announcement was made Oct. 6 in an email to Agency for Health Care Administration employees.

In the current year budget, Sexton writes, the Medicaid program is slated for $25.7 billion, which could increase to $26.4 billion to pay health care costs for elderly and disabled Floridians who qualify.

Kidder is taking the place of Justin Senior, who left Oct. 3 to become the agency’s interim secretary.

Senior replaced Liz Dudek, who has led the AHCA since the agency’s creation in the 1990s.

State records show Dudek was paid $141,000 annually. Senior, who reported directly to Dudek, earns $142,000 a year.

Dudek, who resigned unexpectedly Sept. 21, served as AHCA Secretary for both Gov. Rick Scott and former Gov. Charlie Crist.

Before becoming interim deputy secretary for Medicaid, Sexton notes Kidder served as assistant deputy secretary for Medicaid policy and quality. According to a state government website, Kidder has been with the state since 2001 and earns $120,000.

8 Reasons Rick Scott is the perfect veep for Donald Trump

Rick Scott is basically as awful as Donald Trump in so many ways. But before Floridians start petitioning Trump to introduce Scott to a presidential election turnout and an embarrassing loss before Scott runs for U.S. Senate in 2018, read all eight reasons.

8) Cons. Scott didn’t build his $300-some million fortune with a fraudulent university, but he did help build a company that defrauded Medicare and Medicaid by way more, paying a record $1.7 billion fine.

7) Muslims. Scott was offending Muslims and Hispanics long before Trump descended down the escalator at Trump Tower. Scott put some of his first campaign dollars into fearmongering about Muslims in “Obama’s Mosque” near Ground Zero in 2010. Also, mic cut.

6) Hispanics. Similar to Trump, and despite all evidence, Hispanics love Scott, according to … only Rick Scott. Scott claims he “won” the Hispanic vote in 2014, despite actually losing it by 20 percent.

5) Little Marco. While Trump’s insults are infamous, Scott is doing his part in Florida. He backed Trump over Rubio (and Jeb!) and is now working against Rubio in his U.S. Senate race, supporting mini-Trump Carlos Beruff, best known for unapologetically calling President Obama an “animal.”

4) Smarts. Trump could own Anderson Cooper‘s “RedicuList” segment, but Scott once got on it for insulting “everybody’s intelligence” trying to defend himself for using on-duty cops at campaign events.

3) Votes. Trump needs turnout to be as depressed as Jeb! after South Carolina. Scott has been hard at work, rolling back civil rights reforms that allowed nonviolent ex-felons to vote.

2) Money. Scott won in 2014 by outspending his opponent on TV by $33 millionRomney lost Florida by less than 1 percent in 2012, but only outspent Obama by $17 million. An extra $16 million might have bought 29 electoral votes.

1) Florida. Trump can’t win without Florida, and Rick Scott knows how to win here.

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Kevin Cate owns CATECOMM, a public relations, digital, and advertising firm based in Florida.

Geraldine Thompson: Profits ahead of patients spells trouble for Floridians

As a longtime community advocate and state legislator in Orlando, I work every day to make sure that consumers in Florida have access to quality, affordable health care. The recent approved mergers of Aetna with Humana and Anthem with Cigna pose great challenges for Florida consumers.

While the idea of mergers to create bigger companies may seem like a good idea – the results can be disastrous. As citizens, we must demand that mergers like these are held up to the highest standards, and that the process is transparent, open and fair.

Although companies merge for a variety of reasons, the most important to them is that they increase their bottom line. Because of this, it is our responsibility to make sure that we keep up our standard of care, even while the insurance companies are working to cut access to health care for our hardworking Florida residents.

According to a health economics expert at the University of Southern California’s Schaeffer Center for Health Policy and Economics, “when insurers merge, there’s almost always an increase in premiums.” We are concerned that the increased market power post-mergers of Anthem-Cigna and Aetna-Humana will lead to rising costs for Florida, when they are already seeing a rise in health insurance premiums and where things are projected to rise significantly in 2016.

We have seen in the past that mergers lead to consumers paying higher premiums, are made to suffer through limited networks and most importantly, they wind up receiving worse service.  A proposed consolidation of health insurers, now under consideration by the Florida Office of Insurance Regulation, will affect millions of Floridians.

Mergers like these will do away with competition, which is a critical component of lowering costs, and promoting access and choice.  These mergers will also create new, dominant insurance entities that have no incentive to improve care.

According to industry experts, these mergers could “undercut” the critical innovation efforts needed to improve health care. This would not only harm consumers as insurers compete less with providers to offer new insurance products, but a concentrated insurance market like this often has less innovative offerings.

Additionally, with less competition to bring innovative health care to customers, we will likely see a decrease in quality of care and a lack of access to innovative products that often deliver better care at lower costs.

Floridians already feel the pain from a lack of expanded Medicaid access in the state, but, with the mergers of five major insurance carriers, more Floridians will without a doubt see higher prices due to less competition in Florida’s health care marketplace. Over 88 percent of Floridians are clear in the message that the pending mergers are driving concerns up and competition down.

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State Sen. Geraldine Thompson represents Senate District 12, which includes parts of Orlando and western Orange County.

SEIU Florida endorses Patrick Murphy for U.S. Senate

SEIU Florida — which has led the “Fight for $15!” campaign to raise the minimum wage in Florida over the past two years — announced on Monday that it is endorsing Jupiter U.S. Rep.  Patrick Murphy for the U.S. Senate.

“Congressman Murphy is well prepared to serve as our United States Senator and has earned the support of SEIU Florida members across the state by aggressively fighting for policy solutions that are important to Florida’s working families,” said Monica Russo, president of SEIU Florida, in a statement. “We support candidates who are willing to be a champion and a voice for working-class families who are sick and tired of being pushed aside. Patrick Murphy is one of those candidates.”

In its statement announced its support, the SEIU — one of the most politically powerful unions in Florida — noted how Murphy demonstrated his commitment to raising the minimum wage to $15 an hour by taking the union’s “minimum wage challenge” last year. That’s when he took up the proposal (as have other Florida lawmakers) to live on just $85 a week to bring attention to the impact of low wages, and his solidarity with that movement.

The SEIU also applauded Murphy for advocating for Medicaid expansion in Florida,  noting that “He is committed to closing the coverage gap for nearly 1 million Floridians and the millions of Americans around the country who don’t have access to quality, affordable healthcare.

“The vast, vast majority of people on minimum wage want to be working, want to be making more money, want to be giving more back to the community, are doing a lot of jobs that are very important, and they deserve to be paid more,” said Murphy. “It’s unacceptable to be on the minimum wage, be working 40 hours a week, and live in poverty. That’s unacceptable in this country.”

It should be noted that Orlando-area Congressman Alan Grayson, Murphy’s top competitor in the Democratic primary, also took the minimum wage challenge this past March.

According to the SEIU Florida’s website, the labor union represents more than 55,000 active and retired healthcare professionals, public employees, and property service workers in the state of Florida.

Judge sets date in settlement of decade-old Medicaid reimbursement lawsuit

A Miami federal judge has agreed to a hearing date for the settlement of a decade-old class-action lawsuit over children’s Medicaid services in Florida.

LobbyTools reports that Friday the judge set a June 28 hearing to formally consider the settlement in a suit that seeks to increase medical and dental services to nearly 2 million Florida children.

Pediatricians are hopeful the state will honor its agreement.

“Like any settlement, it’s a compromise,” says attorney Carl Goldfarb, who represents pediatricians. “Both sides gave certain things up. But we think it’s in the best interest of the children of the state and we think it will improve their access to care.”

Doctors and dentists brought the suit more than a decade ago, arguing that low Medicaid reimbursements in Florida denied preventative care to as many as 500,000 children.

The settlement mandates the state to give significantly higher payments. However, LobbyTools notes that other specialists who participate in the Medicaid program may not comparable increases.

Andy Gardiner, Lars Houmann, call for more health care access, but not Medicaid

At an industry-sponsored summit in Orlando Tuesday, outgoing Florida Senate President Andy Gardiner and the leader of one of Florida’s biggest hospital system both called for urgent help in providing more access to health care.

But not through Medicaid.

Gardiner, an Orlando Republican, and Lars Houmann, president of the Florida Division of Adventist Health System, told the Florida Health Care Affordability Summit that the great challenge is opening up health care to uninsured and low-income residents of Florida.

“I would encourage you to also talk about access, and access for all individuals,” Gardiner told the forum, organized by the Associated Industries of Florida.

They both said Florida has another chance, and should take it, to negotiate with the federal government for a waiver from the federal Medicaid program that might allow the Sunshine State to take federal Medicaid expansion money but use it for alternative programs to Medicaid.

For the past three years, the federal government has been trying to encourage states to accept money to expand Medicaid programs to provide coverage for people too poor to buy Obamacare insurance, but who make too much money to qualify for Medicaid. In Florida’s case, that’s about $50 billion over ten years. Gardiner’s Senate has twice crafted deals to negotiate waivers with the federal government for Florida-driven programs, but the Florida House has refused.

“If the desire in the state of Florida is not necessarily to look at free-market options, that is for a debate for another day, I would encourage you to talk about models like the money we put into free and charitable clinics,” Gardiner said.

Houmann also urged expansion of access to uninsured and laid out economic slides showing what they cost hospitals and Florida.

He also stressed that at Adventist Health, which runs the Florida Hospital systems in Orlando and Tampa Bay, the strategic thinking is turning toward keeping people healthy — keeping them out of hospitals.

Yet he argued that Medicaid is just a bad program for both patients, doctors and hospitals, and should not be expanded, but replaced with something that works better. Medicaid, he argued, comes with too many strings and too little money to be a good business for doctors or hospitals, and patients are punished because few doctors accept it, and their services suffer from overload.

“Yes, it is an entitlement program. Yes, it does take care of a larger part of our population,” he said. “But frankly, I could not put my heart into term ‘expand Medicaid.’

“I could put my heart into bringing the money that the Affordable Care Act made available for Florida for expanding coverage,” he added. “Frankly, this is a political lecture; we did have an opportunity to bring a deal to Washington … to restructure our program. But we couldn’t get that done.”

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