Family Battles Medicaid Managed Care For Access To Specialist

Jan 27, 2016

As a mother, Anya Staton says her primary instinct is to feed her children.

So when her oldest son developed an eating disorder she knew he needed help -- help she didn't know how to give. 

And care the family's insurance company, through Florida's Medicaid program, denied the boy needed.

Her family's experience is just one of several highlighted recently as part of a Sarasota Herald-Tribune series on Florida's Medicaid program, one that has transitioned to a system where private companies manage care for low-income children, families and the disabled.

While the Herald-Tribune found that most patients in the program can get primary care, it discovered a different situation for those trying to find specialists.

Anya Staton, for example, spent months trying to get her son, Malik, into in-patient behavioral treatment for his eating disorder.

"The care is actually there, but it's like hidden under a hundred layers of things that you have to keep fighting and fighting and fighting to get through, and none of is it simple,” Staton told the Herald-Tribune and Health News Florida. “None of it is easy to find."

Malik was admitted for the first time to Sarasota Memorial Hospital in the winter of 2014, and was diagnosed with anorexia, obsessive compulsive disorder and depression. 

He was treated for weight loss and a low heart rate, but his mental health was never addressed. He would spend months in the hospital, yet when he was sent home, his mother said he still wasn't well.

"I would make him sleep with me at a certain point, and just keep my hand on his pulse, on his heart, and just constantly shake him all night, because I was sure, that one day he wasn't going to wake up," Staton said.

The insurance company handling Malik's care for Medicaid -- Integral Quality Care -- declined to comment on his case.

In January 2015, a caseworker with Sarasota Memorial started searching for an in-patient facility that would treat Malik. The first denial letter from the insurance company arrived at Anya Staton's home in June 2015. The dispute persisted until August, when Staton, caseworkers and the insurers met during a telephone administrative hearing with Medicaid officials. 

"There is absolutely nothing in comparison to what it felt like to be completely helpless," Staton said. "And to as a mother, want to be able to fix thinks and make your child feel better, and having no tools and no understanding, and just being so frustrated."

Read more of Malik’s story from the Sarasota Herald-Tribune here.

This story was part of a project for the Dennis A. Hunt Fund for Health Journalism and the National Health Journalism Fellowship, programs of USC Annenberg's Center for Health Journalism.

Lottie Watts is a reporter and producer with WUSF in Tampa. Health News Florida receives support from the Corporation for Public Broadcasting.