MIAMI — State health officials are moving tens of thousands of Medicaid patients with serious medical conditions into managed care plans, but health care plans are worried the patients won't be able to afford the proposed monthly premiums.
The state pays the monthly medical bills of patients with high health care costs under the Medically Needy program. Patients must meet a share of the cost each month that varies based on their income.
The state spends more than $900 million a year to provide services for at least one month to more than 250,000 people a year. But under a new Medicaid privatization plan, the state is asking those patients to start paying roughly $120 a month to receive services. If they can't pay, they are kicked out of the program after a 90-day grace period and have to re-qualify. Advocates worry the change could lead to lapses in care for a population with serious chronic health conditions such as cancer, heart disease and HIV.
At a public meeting on the issue in South Florida this month, representatives from health care plans warned patients won't be able to pay the proposed $120 monthly costs in a down economy, leaving health care plans on the hook.
"We believe there's going to be a high incident of nonpayment," said Michael Garner, president of Florida Association of Health Plans Inc.
"We're going to ask you to pay premiums every month and if you don't, you're going to lose your coverage … we're talking about transplant patients, patients with HIV AIDS, cystic fibrosis, patients with very serious health conditions and a single month gap could lead to very serious consequences," Garner said.
It will be the first time private health care plans in the state will provide coverage for medically needy patients and experts say it's a difficult and expensive population to cover because they have serious health conditions and often have low incomes.