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 firstname.lastname@example.org.