TALLAHASSEE — Florida pediatricians say an expected legislative move heightens worries about what will happen to young special-needs patients as the state privatizes the Children's Medical Services program over the next three months.
The changes are part of a larger transition for Medicaid patients from a fee-for-service delivery system to one in which they would be enrolled in prepaid health plans. Thanks to a 2011 law revamping Medicaid, Children's Medical Services must make the transition to managed care by Aug. 1.
Some pediatricians say the transition has been poorly planned and late in getting the word out and contracts signed.
"This means the 70,000 CMS children will be thrust into the unknown," said Sam Bell, a retired lobbyist who helped start Children's Medical Services while he was a lawmaker from Volusia County in the 1970s. "These kids are going to be out there without medical homes and unable to get services. It's going to be a crisis."
Pediatricians thought they had a stopgap in Senate Bill 2512, which extended CMS as a fee-for-service option throughout the changeover. But Sen. Denise Grimsley, chairwoman of the Senate Health and Human Services Appropriations Subcommittee, said Wednesday that the Senate would accept a House Medicaid bill (HB 5201), which does not contain that option.
"I don't think it's needed," said Grimsley, R-Sebring. "The Department of Health and (Agency for Health Care Administration) are both telling us CMS is ready."
Department of Health communications director Nathan Dunn said his agency objected to the fee-for-service option because it could delay the rollout of Medicaid managed care.
Justin Senior, deputy secretary for Medicaid at the Agency for Health Care Administration, said that kids enrolled in Children's Medical Services can stay there in fee for service until Aug. 1 if their parents so choose.
But pediatricians say families aren't being informed of that.
Louis St. Petery, a pediatric cardiologist and executive vice president of the Florida Pediatric Society, said he's been getting calls from worried parents. He pointed to families that had already chosen a Medicaid HMO, thinking they were choosing Children's Medical Services, and were taken off the CMS rolls as a result.
"The nurses were telling me they can't even make appointments for my patients down the road, and they've got to right this wrong," St. Petery said. "They've got to get them back in the CMS network. This is crazy."
Bell and St. Petery say they've tried repeatedly to address their concerns directly to DOH and AHCA, but that communications between the state and the pediatricians are further complicated by a lawsuit that has been pending for years.