Florida Seeks Changes in Medically Needy Program

By: Jim Saunders, The News Service of Florida
By: Jim Saunders, The News Service of Florida

THE CAPITAL, TALLAHASSEE, May 9, 2012

Jim Saunders, The News Service of Florida

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.


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  • by me Location: Florida on Jun 4, 2012 at 04:34 PM
    as usual the poor have no rights why not take some of the taxes from the rich to help the less and the sick and poor God willneverr honor this yourt all greedy who is doing this to old sick and disabled makes me ill.this world is getting so sad
  • by M~ Location: Tampa on May 29, 2012 at 12:58 AM
    @barely, read up on this before you take a position! Ive just spent last 3hours digging....the "Premium" will be the lower or either what your SOC is now or their estimated cost of coverage based on your history, AND you have to pay it every month EVEN IF YOU HAVE NO MEDICAL EXPENSES ONE MONTH! Though pain to track SOC monthly, under current system, if you meet or exceed that dollar figure all at once, you don't pay that bill so possible to have no out of pocket expense, not so under new, will be paying out every month.
  • by Concerned in Tally Location: Tallahassee on May 10, 2012 at 07:13 AM
    There is quite a bit wrong with this program. I am a hardworking individual who has been a non-benefit employee for better than eight years now. I don't mean qualifications for medicaid because of my assets and income and I don't meet the medically needy program because I'm career focused and had sense to know when enough children was enough and had a tubal ligation. Sadly there are quite a bit of programs designed to maintain the comfort zone of the rich, and the dirt poor while the working class pays for it all.
  • by barely surviving on May 9, 2012 at 08:31 PM
    I usually don't post but being a medically needy recipient,want to shed some light my spouse has lung cancer we have a share of cost around $1600,we also have medicare which covers 80%,which makes it hard to meet "shareofcost"often stuck with large bills we can't pay!!our income is about 2600 mthly family of 3, a premium vs shareofcost I vote yes!not fond of timelimit in program idea,
    • reply
      by Concerned in Tally on May 10, 2012 at 07:20 AM in reply to barely surviving
      I feel your pain; after 10 years of suffering I had a progression in the episodes of migraines that was so bad I thought I was suffering a stroke I went to the E. R. to be diagnosed with a disorder that affects an enlarged nerve in the back of my brain. Because of my circumstances and not being of retirement age or unmotivated I was left with a bill of $2,932.00 for that emergency room visit. A necessary visit because my condition if untreated could have lead to massive stroke, aneurism and possibly death. There is a lot wrong with the system and the Federal government must start at the top on clean up… as my Mom often said “it’s time to shape up or ship out”.
  • by Black flag on May 9, 2012 at 06:03 PM
    I was just looking at the .pdf file for the Medically Needy Program and the example they give for a medical bill is "Your share of cost is $800. You go to the hospital on May 10 and send us the bill for $1000. You have met the share of cost and are Medicaid eligible from May 10th through May 31. Medicaid will pay the $1000 medical bill." Where's that mysterious extra $200 coming from? I've never heard of this program until today, I'm usually against anything government but as long as this program isn't wasting money I support this program. I'm going to pull the papers on this program in the morning at work... I have an interesting job.
    • reply
      by Me on May 10, 2012 at 05:59 AM in reply to Black flag
      BUT if you were to turn in your medical bills for May 10th. You SHOULD have coverage till the end of the month, BUT you never find out you are covered until June 1st!
  • by M on May 9, 2012 at 04:48 PM
    How about we have the manual labor employment agencies do welfare home visits? If there's an able-bodied person in the home, they offer them a job. If they refuse, they get their benefits cut. Maybe they could even have their own van/RV, like the new mobile health services. Cutting benefits from those who are truly in need of them is disgusting in light of all of those who are doing nothing but wasting space at our expense.
  • by Moonlight Location: river bridge on May 9, 2012 at 01:20 PM
    This is a republican controlled state. They believe that the old, sick poor people should either take care of themselves or just die.
    • reply
      by CommonSense on May 10, 2012 at 05:35 AM in reply to Moonlight
      No, this is a 'common sense' state where we'd rather operate with a surplus budget instead of deficit by handing taxpayers' money out to people who are too lazy to get off their behinds and get a job. We'd rather promote self-dependency instead of state-dependency.
  • by Anonymous on May 9, 2012 at 10:42 AM
    This is a program wherein the medically needy person and/or his family member(s) works and brings in income to attempt to deal with a medical condition they were more than likely born with instead of just living off of the government. While those who are 100% capable and able-bodied could care less about being responsible and making a living off of the government get everything for free. Thanks for continuously sticking it to us!
    • reply
      by truth on May 9, 2012 at 01:10 PM in reply to
      the tea party republican way, cut your health care, while raising theirs!!!
  • by Bubba on May 9, 2012 at 09:10 AM
    Classic Florida tea bagger initiative. The state is full of poor old folks who won't be receiving medical services much longer. Way to cut spending!
    • reply
      by Agree on May 9, 2012 at 10:47 AM in reply to Bubba
      This I agree with we have the poor and they will not leave this is the balance of the nation. The Elite tries to push them more to the bottom. I pray that we open our eyes with some love.
      • reply
        by me on Jun 4, 2012 at 04:36 PM in reply to Agree
        amen
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