Will Low Bidder Care for Kids?

Sep 11, 2014

In an ordinary house on an ordinary street near Orlando live some extraordinary children. To stay alive, they depend on machines and tubes and the caregivers sent out by an agency called Children First.

Registered nurse Maria Schiavi, co-owner of Children First, says some of the kids they care for were injured in an accident, such as a near-drowning. Others were born with life-threatening problems that modern medicine can’t fix.

“This is little Juvens; he is about the size of a newborn even though he's about five months old.. Are you listening to me? Yes! He is unfortunately going to need a tracheostomy and he'll also need a ventilator..." she said as machinery noise fills the room. 

"This is our little girl Yamaria. Yamaria’s on full life support system. She suffered a near SIDS. She has a tracheostomy, as you see, she’s hooked to a life-support ventilator, she does have a feeding tube in her stomach.”

Yamaria gives no sign she knows we’re there. She’s in a coma. We move on to another room, another 4-year-old girl. This one is conscious, aware of her surroundings. But she can’t move. She can’t talk.

“This is the oxygen concentrator that supplies a continual flow of oxygen to our Angel, who is totally ventilator-dependent, due to her diagnosis, which is spinal muscular atrophy. She's watching..this is her portable DVD that her grandpa gave her. --I don’t know that movie -– she fully understands, she cannot verbalize, no," Schiavi said. "This part of the disease process is very unfortunate. She seems as though she’s frozen.”

These children don’t know it, but their world is changing. The state of Florida’s Medicaid system has moved each of them into an HMO, and most have turned their home care decisions over to another company, Univita Health. By the end of the month the children may have a whole different set of nurses and therapists, maybe a different home. It depends on how Univita decides to handle it.

They’ll be customers of a company that is willing to provide their services and medical equipment for whatever is the low bid. Schiavi’s partner at Children First, who handles negotiations with HMOs, is Donna Loggie.

She says all the Medicaid HMOs around Orlando and much of Florida are contracting with the same company, Univita Health, to handle their home medical equipment, called DME.

“They offered the Medicaid DME providers around the state 50 percent of the Medicaid fee schedule,” she said.

In other words, a $100 payment under traditional Medicaid would now pay only $50.

“There isn’t a provider in FLorida that could sustain doing business with 50 percent of the current Medicaid fee schedule," Loggie said.

She told Univita how sick the children here are, how much high-tech equipment they need, and how much training the staff must have. She asked: Can we negotiate?

“And Univita’s response was, ‘Well, that’s what we’re offering. You can take that or leave that.. And we left that,” she said.

Home care providers say Univita has a conflict of interest because it has its own home care division.

Michael Muchnicki, Univita’s president and CEO, says he can’t discuss contracts and payments, that those are trade secrets, kept confidential.

Justin Senior, Medicaid director for Florida, says the whole point of shifting to statewide managed care is to bring costs under better control in an industry long known for abuse and fraud. Bidding should make it clear what a fair price is, he says.

“What the legislators wrote was that any provider could participate in the program if they're a DME provider as long as they agree to the lowest price that any other DME provider meets in the region, as long as they met applicable quality standards," Senior siad.

"If Univita enters into a dirt-cheap contract with itself, it cannot then use that dirt-cheap contract as the lowest price agreed to by another  provider in the area. That's the first type of gaming that we said, 'That is not going to be permitted.'"

Senior says Medicaid’s competitive bidding resembles what Medicare has been doing; government reports show bidding dropped medical equipment prices for Medicare by $400 million in the first round of bidding.  

"For several years now, the Medicaid  rates in Florida in those metro areas have been significantly higher than Medicare rates, around 40 percent," he said.
 
Senior says Medicaid will watch for complaints and will be doing consumer report cards that reflect HMO member surveys. But the small suppliers like Children First feel the game is rigged against them.
 

See related story: Home-Care Firm Rules Medicaid Market.

--Health News Florida is part of WUSF Public Media. Contact Editor Carol Gentry at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.