State AIDS, Mental Health Changes Spur Protests

Jul 19, 2018

Gov. Rick Scott is coming under fire for his administration's decisions to shift tens of thousands of patients with serious mental illness or HIV into new Medicaid health plans in the coming months, changes that could force many patients to switch doctors.

The backlash has included newspaper ads across the state as well as protests, including one staged Wednesday outside the governor’s beachfront home in Naples.

After a lengthy bidding process, the state Agency for Health Care Administration is preparing to sign new five-year Medicaid contracts with 13 managed care plans.

But it also wants to end ties with other plans, including two “specialty” health plans that, combined, account for 90 percent of the specialty-plan enrollment in the state.

Positive Healthcare --- a managed-care plan that covers about 2,000 people with HIV or AIDS in Broward, Miami-Dade and Monroe counties but would lose its contract --- is asking a state administrative judge to prevent the Agency for Health Care Administration from moving ahead.

So is Magellan Prepaid Mental Health Plan, which manages care for about 80,000 people with serious mental illness but also wasn’t chosen by the state to provide Medicaid coverage beginning next year.

Owned by the AIDS Healthcare Foundation, Positive Healthcare has taken aim directly at Scott by pushing ahead with protests against his administration.

It has twice placed full-page advertisements in newspapers across the state, running them as recently as last week in papers such as the Tampa Bay Times, Miami Herald, Sun Sentinel, and Orlando Sentinel.

The ad features a picture of Scott grinning and asks: “Do you care about people living with AIDS?” The words “do you care” are spelled out in blood-red type and provide a sharp contrast to the otherwise black and gray advertisement.

“The reality is, Florida is the epicenter of the nation’s AIDS epidemic,” the ad said. “Governor Scott needs to make sure that HIV patients have the choice of where to go to get their care.”

The governor’s office refuted the ad’s message.

“It’s totally false to say that HIV services are being reduced. Florida is actually doing the opposite,” Scott spokesman McKinley Lewis said in a prepared statement.

Lewis said the dispute has “nothing to do with helping patients --- this is just about a private vendor being upset that the state will be contracting with someone else to do more for this vulnerable population.”

But AIDS Healthcare Foundation official Mike Kahane said it’s Scott --- who made his fortune establishing the nation’s largest for-profit hospital chain --- who has made the vendor the priority.

The Agency for Health Care Administration announced in April that it would sign statewide contracts for HIV and AIDS care with Clear Health Alliance, an HMO owned by Simply Healthcare. Positive Healthcare, meanwhile, would not be awarded specialty contracts in Medicaid regions 10 and 11, which include Fort Lauderdale and Miami, ground zero for new HIV infections.

Kahane, who is charge of the AIDS Healthcare Foundation’s business operations in the United States and the Caribbean, said it “raises suspicions” that the agency chose a for-profit company to become the statewide AIDS specialty provider and eliminated its only competitor, a non-profit run by a large national AIDS organization.

“At the end of the day, it’s much easier for AHCA to be dealing with a for-profit business than it is for them to be dealing with an advocacy organization,” said Kahane, who predicted that if the state moves ahead with its plans to drop Positive Healthcare “people are going to fall out of care and have their care interrupted.”

An AIDS patient, who requested that he only be identified by “Wendell “J” because of privacy concerns, could be one of those patients.

He was diagnosed with HIV, the virus that causes AIDS, in 1984 and told The News Service of Florida that he contracted it in Miami after years of unprotected sex. Though he’s had the virus for more than three decades, he said he’s been able to remain relatively healthy because of the relationship he’s cultivated with his physicians and his strict adherence to their orders. He has been a member of Positive Healthcare for several years.

“It seems like every time something starts going good for a person, the devil goes right in there and knocks it right on out,” he said. “I hope I don’t have to change.”

Florida lawmakers in 2011 approved an overhaul of the Medicaid system to require most beneficiaries to enroll in HMOs and other types of managed-care plans. It divided the state into 11 regions and contracted with health plans in each region.

Medicaid recipients with serious mental illness, HIV or AIDS have the opportunity to choose a specialty plan, a “standard” managed-care plan, which offers preventive and acute care services, or a “comprehensive” plan, which covers everything from mental-health services to labor and delivery to long-term care.

If they do not choose a plan, they are assigned by the state to the specialty plan.  

An initial round of contracts stemming from the 2011 Medicaid overhaul expire at end of this year. The state spent more than a year working on re-procurement of the contracts and announced the names of the health plans it would sign agreements with in April. In all, the various contracts are expected to be worth at least $90 billion over five years.

But some health-care providers are concerned it won’t be easy for patients, such as those with serious mental illness, to determine which doctors they can use because of the changes in plans.

“Many people with mental illness are very concrete in their thinking, and it’s a little bit more difficult for them to understand that it’s not personal that the doctor won’t see them and that it’s the insurance, not them,’’ said Andrea Katz, CEO of Archways, a mental-health provider based in Fort Lauderdale.

Katz added that people can begin wondering where they will go and who will help them.

“There’s sometimes a bit of an over-reaction, but to them it’s not an over-reaction because it’s how they are feeling because they aren’t sure what they should do,” she said.

In a challenge filed in the state Division of Administrative hearings, attorneys for Magellan Prepaid Mental Health Plan accused the state of underestimating the impact the changes will have on Magellan’s 80,000 patients if the contract decisions stand.

“Transitioning a large number of individuals with (serious mental illness) to a new plan will disrupt member continuity of care, decimate the progress that has been made to stabilize the health of these members, and increase cost to the system by having members ‘start all over again,’ ” Magellan attorneys wrote.

AHCA announced in April that it would sign specialty contracts with WellCare of Florida to provide coverage for people with serious mental illness across the state. Instead of seeing its Medicaid presence expanded statewide, Magellan found itself being blocked out of Florida’s lucrative Medicaid market.

Jay Reeve, president of and chief executive officer of Apalachee Center, which provides mental-health services in Northwest Florida, said his company has good relationships with the current Medicaid health plans and has already been contacted by new plans.

But Reeve is concerned with the magnitude of the changes, noting that Medicaid beneficiaries in his area will no longer have access to Magellan and two other Medicaid managed-care plans. Reeve said his center treats upward of 5,000 Medicaid patients annually, and as many as half of them will be forced to change plans.

“Anytime you make a change of this magnitude there’s potential for confusion and there a potential for things getting lost in translation a little bit,” he said.

WellCare spokesman Charles Talbert touted the company’s success, noting that WellCare has more Medicaid enrollees in its health plans than any other company.

“Our selection to expand our Medicaid services in the state is recognition of our proven track record and ability to help our members in Florida live better, healthier lives,” Talbert said in a statement.