4/20/2009 © Health News Florida
The state Medicaid program will "ensure a smooth transition" for recipients with serious mental illness whose caregiver networks were bought by corporate HMOs, a statement from the Agency for Health Care Administration says.
Thousands of beneficiaries affected by the sale of Access Health Solutions and NetPASS to subsidiaries of national HMOs will remain in the same prepaid mental-health plans until the HMO's specialists assess them and set up a transition plan, the statement says. Prescription medication remains covered, as well.
Medicaid beneficiaries have 90 days after reassignment to an HMO to leave it and remain with their current mental-health treatment plan, the statement said.
So the accusation leveled last week by Florida CHAIN -- that thousands of Florida Medicaid patients who were being treated in specially-designed mental health plans had been switched without warning or consent into HMOs -- is not true, AHCA said in a statement released by spokeswoman Shelisha Durden.
"Florida Medicaid is meeting all federal Medicaid regulatory requirements..." it said.
Earlier Friday, Health News Florida published a report based on a letter from the advocacy group's interim executive director,
Lisa Margulis Grossman, to AHCA Secretary Holly Benson protesting "forced reassignments" of mentally ill patients. She warned that such a "backdoor expansion of HMOs" appeared to violate state and federal Medicaid regulations that require patients to be notified before changes take place.
Patients in four counties – Hillsborough, Pinellas, Pasco and Miami-Dade – have been affected so far by the sale of Access Health Solutions and NetPASS to Molina Healthcare and Centene Corp., Grossman said in her letter. She predicted similar events in other counties.
“Many of these affected recipients are seriously emotionally disturbed children and severely mentally ill adults who specifically chose (Access Health and NetPASS because they) provided them with a medical home,” Grossman wrote.
"We take issue with the allegations raised by Florida CHAIN," the AHCA statement said. The agency's contracts carefully provide for continuity of care, it said.
"The Agency partners with the health plans to ensure a smooth transition for beneficiaries...," the statement said. "Prior notice is provided 60 days and 30 days before a change, and beneficiaries are given the opportunity during these time frames to choose a plan or pick a MediPass provider." MediPass is more like traditional Medicaid, managed through a primary-care practice. If they go into MediPass, the AHCA statement says, they can continue to receive mental health care in the same arrangement they had before.
"As with any managed care enrollee, a beneficiary can disenroll from their plan and choose another provider at any time for good cause,' the statement added.