Make us your home page
Instagram

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

Medicaid overhaul launches in Tampa Bay next week

Florida's privatization of its Medicaid program hits a milestone next week when nearly all Tampa Bay beneficiaries will have been moved into managed care plans.

Though the controversial shift has been debated in Tallahassee for years, many of the poor and disabled Floridians on the federal-state insurance program are only now starting to understand how the mandate affects them, including the possible loss of their doctors.

State officials, who are rolling out the program one region at a time, say they beefed up call centers and Web capacity to help consumers. They built in protections to ease the move, such as requiring HMOs to continue paying for patients' current treatments and medications for 60 days.

"We don't want providers canceling appointments, even if they're not in network," said Justin Senior, director of Florida's Medicaid office. "We're trying to minimize any changes that occur as a result of the rollout."

But the transition, expected to be completed statewide by Aug. 1, hasn't been easy for some of the 1.5 million Floridians transferred from the traditional program into private plans. An additional 1.4 million Medicaid beneficiaries were already in managed care, though many of them may have to change plans.

Community health centers and county social services offices have been fielding calls from Medicaid recipients who don't understand what's happening. Hernando County's Health and Human Services department has tried to help more than a dozen residents get information off the state website, said manager Veda Ramirez.

"They simply didn't get enough information," Ramirez said.

In St. Petersburg, Gail Cohen, a 64-year-old disabled resident, said the letter she got from the state in April was the first time she'd heard about the change. She said the HMO she chose didn't include her primary care doctor and that her six specialists aren't participating in any of the plans. Now she fears she won't get the medications for her immune deficiency disorder.

"I'm very nervous because my health is so complicated," she said.

The Medicaid program covers poor residents, mostly children and pregnant women, along with the disabled.

Putting nearly all those patients into managed care is a long-standing issue in Florida, where Republican leaders see it as a way to save money. The state began experimenting with the idea in 2006 with a pilot project in five counties.

Results were mixed, with doctors complaining about not getting reimbursed, and plans abruptly pulling out of the program. Georgetown University researchers studied the pilot and concluded that any savings came at the expense of care.

In 2011, the Florida Legislature opted to take the program statewide. That also included moving elderly Medicaid patients in long-term care into the plans, which finished earlier this year.

Before approving the Legislature's move, the federal government required Florida to put in a number of protections, including requiring plans to include a certain number of physicians in each county.

Joan Alker, executive director of the Center for Children and Families at Georgetown, said the changes could be much better for doctors and patients, though that remains to be seen. "I think there are a lot of great protections on paper," she said. "But I'm very worried they may not be fully implemented and monitored."

The new set-up divides the state into regions, each with a certain number of plans offered. In Pasco, Pinellas and Hernando, there are four plans. Hillsborough has seven. People can pick a plan or, if they don't, are automatically enrolled in one chosen by the state.

So far, about 25 percent of recipients statewide have picked a plan and 40 percent were auto-enrolled, according to the Agency for Health Care Administration. Another 35 percent already had a plan and were able to remain in it. If a relatively low percentage of people voluntarily picks a plan, it could indicate beneficiaries don't understand their options, Alker said.

Senior said his office is confident the new program has sufficient fixes to help prevent many past problems. "We've put a lot of effort and thought in how we structure the program," he said.

Jodie Tillman can be reached at (813) 226-3374 or jtillman@tampabay.com.

. fast facts

How to get help

The statewide rollout for nearly all Medicaid patients should be completed by Aug. 1. Hernando County went live May 1. Hillsborough, Pasco and Pinellas launches Sunday. Medicaid recipients with questions may contact their local Medicaid office or talk to state counselors. Counselors can be reached toll-free at 1-877-711-3662. More information is also available at flmedicaidmanagedcare.com.

Medicaid overhaul launches in Tampa Bay next week 05/25/14 [Last modified: Monday, May 26, 2014 1:11am]
Photo reprints | Article reprints

© 2017 Tampa Bay Times

    

Join the discussion: Click to view comments, add yours

Loading...
  1. Rays morning after: Wilson Ramos showing glimpses of what's possible in 2018

    Blogs

    The real payoff for the Rays signing C Wilson Ramos last off-season will come in 2018, when he can play a full season fully recovered from right knee surgery.

    And Ramos is giving the Rays a pretty good glimpse of what that can be like.

    In Friday's 8-3 win over the Orioles, he hit a grand slam - …

  2. Buccaneers-Vikings Scouting Report: Watching Kyle Rudolph, Adam Thielen and Everson Griffen

    Bucs

    No matter how much film we study, no matter how much data we parse, we just don't know how an NFL season will unfold.

  3. Pinellas construction licensing board needs to be fixed. But how?

    Local Government

    LARGO –– Everyone agrees that the Pinellas County Construction Licensing Board needs to be reformed. But no one agrees on how to do it.

    Rodney Fischer, former executive director of the Pinellas County Construction Licensing Board Rodney, at a February meeting. His management of the agency was criticized by an inspector general's report. [SCOTT KEELER   |   Times]

  4. Sue Carlton: Job or family when a hurricane's coming — a very Florida conundrum

    Hurricanes

    It must seem as foreign to Northerners as shoveling snow is to those of us raised in the Sunshine State: The very-Florida conundrum of having to choose between work and family — between paycheck and personal safety — when a hurricane comes.

    A hurricane helps the rest of us acknowledge the police officers, paramedics, hospital personnel, public works employees and others who stay on the job despite the storm. 
  5. After Tampa concert, Arcade Fire members party, preach politics at Crowbar

    Blogs

    After waiting more than a decade for Arcade Fire’s first appearance in Tampa, fans didn’t have to wait long for their second.

    DJ Windows 98, a.k.a. singer Win Butler of Arcade Fire, performed at a "Disco Town Hall" at Crowbar following the band's concert at the USF Sun Dome on Sept. 22, 2017.