Florida Medicaid

Seven years after a U.S. senator cited him as a national example of aberrant practices, the onetime top prescriber of antipsychotic drugs in Florida’s Medicaid program is in federal custody awaiting sentencing on fraud charges.

Settlement Reached In Battle Over Children’s Health Care

Apr 6, 2016
AP

After a court fight that lasted more than a decade, the state and groups representing pediatricians and dentists have settled a class-action lawsuit about care provided to children in Florida's Medicaid program.

The settlement, released Tuesday, came about 15 months after a federal judge found that Florida's history of low reimbursement payments to doctors led to a lack of access to care for many poor children. But the agreement also came after the state argued that an overhaul of the Medicaid system had effectively made the case moot.

Rachel S. O'Hara / Sarasota Herald-Tribune

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.

Florida's annual legislative session gets under way today. WUSF News will bring you live coverage of the governor's State of the State address starting today at 11 a.m. This week on Florida Matters (Tuesday, Jan. 12 at 6:30 p.m. and Sunday, Jan. 17 7:30 a.m.), we will feature highlights of the address, along with the Democratic response.  

Daylina Miller / WUSF

Children who get health insurance through Medicaid go to the dentist about half as often as children in Florida who have private insurance, according to a new study out from the American Dental Association and the Health Policy Institute.

The Florida Department of Health has closed a loophole in the state’s healthcare programs for low income families. The Department has made a deal to provide dental services to foster care children in eight counties.

Health Choices Network

Florida Medicaid, which has been touting its "Managed Medical Assistance" program as a national model, may want to hold off.

The program, which shifts virtually all Medicaid recipients into managed-care plans, underestimated how much their care would cost.

A spreadsheet the Agency for Health Care Administration prepared shows that nearly all HMOs and provider-service networks involved in the program are losing money.

The losses between May and December totaled more than $300 million, and some of the health plans said they could reach $700 million by June 30.

USF Health News

When federal money’s on the table, most states go for it like coupon-clippers at a closeout sale.

But studies show that when it comes to seeking federal money, Florida holds back, particularly in health care. Sometimes, the state changes its mind later and asks for its share of the money, only to discover that it’s too late; other states have made off with it.

Wikimedia Commons

When the 2015 legislative session begins next week, many of the state’s decisions on health care for the poor are on hold as state and federal Medicaid officials negotiate over funding, behind closed doors. Billions of dollars are at stake.

When it comes to health-care funding, Florida’s in a funny position. The state has twice turned down billions of dollars from federal Medicaid that would have covered care for about a million poor Floridians.

This year may be no different.

Florida Board of Medicine

A long-time Miami-area psychiatrist who prescribes heavy-duty drugs in abundance has not been doing it safely, the Florida Board of Medicine said Friday.

Dr. Francisco J. Pages, charged with mismanaging the care of nine patients, needs to be evaluated to see what his knowledge level is, the board decided at a meeting in Stuart. Pages needs training to make up the deficits and close supervision by another psychiatrist for at least two years, the board said.

Tampa General Hospital

Hillsborough County hospitals are scheduled to lose more than $151 million a year in funds for care of the uninsured beginning June 30, according to a report released Thursday.

The scheduled changes to two revenue streams “represent a tremendous loss of federal funding to the county and pose a significant risk,” warns the report by the Community Justice Project, part of Florida Legal Services.

Statewide, the coming annual loss will be $2.1 billion, estimates co-author Charlotte Cassel.

Georgetown Health Policy Institute

Florida’s “safety-net” hospitals – the ones that provide the most charity care -- received another in a series of depressing projections Wednesday in a report from Florida Legal Services.  

Taken together, the three reports issued to date by the patient-advocacy organization describe a pending loss of $2 billion a year to the state’s health-care providers for the poor. Federal funding that has propped them up is scheduled to end June 30, Florida Legal Services said.

Florida's Medicaid managed care system in theory should pay doctors more for services, but "on the ground,'' the program insuring poor children still isn't working, physician Louis St. Petery told a Senate committee, the News Service of Florida reports. He disputed state officials who say the changes they've made erase problems brought up in a lingering, decade-old lawsuit over pediatric care, according to the News Service.

After nearly a decade-long fight, a federal judge ruled that Florida’s Medicaid program violates several federal laws when it comes to healthcare for children.

Judge Adalberto Jordan found the care provided through the insurance program for the poor failed to “promote quality of care or equal access” for kids.

Centers for Disease Control and Prevention

A federal judge has ruled that Florida’s health care system for impoverished and disabled children violates several U.S. laws.

In a ruling Wednesday, U.S. Circuit Judge Adalberto Jordan of Miami said lawmakers had for years set the state’s Medicaid budget at an artificially low level, causing pediatricians and other specialists for children to opt out of the insurance program for the needy.

Jordan said that amounted to rationing of care and exacerbated a shortage of pediatricians, particularly in rural areas.

Credit Florida's Second Judicial Circuit

Florida Healthcare Plus, a Medicare HMO with 10,000 members, was declared insolvent Wednesday and turned over to state authorities.

In such cases, state and federal officials help patients move into other health plans or to traditional Medicare. More information is expected on that today or Friday.

The state Division of Financial Services took over the Coral Gables-based plan immediately after the order was issued Wednesday by Circuit Court Judge George S. Reynolds in Tallahassee. DFS is expected to sell off the company’s assets Jan. 1.

Carol Gentry, Health News Florida

When the Affordable Care Act’s federal marketplace opened last year, Beth and Doug Warner of St. Petersburg asked a navigator to enroll them. But they discovered their income wasn’t high enough to get a subsidy.

Without one, Doug Warner said, the policy for the couple would cost $700 a month. “Basically the choice was, ‘Keep the roof over your head or buy healthcare.'”

It’s one of the great ironies of the health overhaul. Floridians most in need of health insurance -- adults below the poverty line -- are often blocked from coverage the Affordable Care Act provides.

wellcare.com

WellCare Health Plans' stock shot up 7 percent Wednesday after the release of a third-quarter earnings report that showed membership now exceeds 4 million. That's up from 2.8 million members at the same time a year ago, a jump of 43 percent.  

The share price topped $70 for a couple of hours, the first time that has happened since WellCare stock tanked on July 25 at the news that the company would not meet its original financial goals for the year.

Florida pediatricians who care for severely disabled children  say the state's overhaul of Medicaid has left  kids, parents and caregivers in turmoil.

Extremely fragile children, including some with tracheostomies and feeding tubes, face barriers in access to specialty care, physical therapy, home medical supplies and other urgent needs, the pediatricians say.

Carol Gentry/WUSF

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.

The federal government has granted a three-year extension to the Medicaid Managed Care Program in Florida, which requires that almost all Florida Medicaid beneficiaries enroll in managed-care plans, the News Service of Florida reports.

The initial shift towards a statewide managed-care system in Medicaid was approved by lawmakers in 2011 and as of this month, nearly 3 million people are set to be enrolled in the program.

Judge Won't Dismiss Medicaid Lawsuit

Jul 9, 2014
law.fiu.edu

A federal judge refused Tuesday to dismiss a lawsuit that alleges Florida provides inadequate care to children in its Medicaid program, despite state claims that privatizing the program will resolve many of the problems.

Florida’s Agency for Health Care Administration will argue in a hearing today that its new Medicaid managed-care system, which takes full effect next month, should end a legal battle over the quality of care for children in Florida’s Medicaid program. As the News Service of Florida reports, the lawsuit brought by the Florida Pediatric Society says low payment rates mean doctors can’t afford to treat children, thus denying the young Medicaid patients access to physicians. A federal judge will hear the case Tuesday in Miami.

Medicaid Tries HMO for Mentally Ill

Jul 6, 2014

Seeking to improve care and lower costs, Florida this month became the first state to offer a Medicaid health plan designed exclusively for people with serious mental illnesses, such as schizophrenia, major depression or bipolar conditions.

The plan — offered by Avon, Conn.-based Magellan Complete Care — is part of a wave of state experimentation to coordinate physical and mental health care for those enrolled in Medicaid.

Florida Medicaid’s aim to enroll virtually all program beneficiaries into private managed care plans begins its greatest challenge today. The transition in Miami-Dade, Broward and Monroe counties will add more than half a million people to the Managed Medical Assistance program, the Miami Herald reports.

Ninety-three organizations in the state that are working in coalition under the title Health Care for Florida Now are asking Floridians to sign a petition calling for the state to accept federal funds to expand coverage to low-income adults who are in the so-called "Coverage Gap."

In 2013 the Florida House voted not to accept the $51 billion over 10 years in federal funds available for the program under the Affordable Care Act even though the Senate approved it and Gov. Rick Scott said he would sign it.

In 2014's session, the debate never occurred.

Two nursing home executives have accepted a plea deal that would ban them from ever taking Florida Medicaid or any federally funded health care payments, the Palm Beach Post reports.

 

Courtesy of Gilead Sciences Inc.

Florida Medicaid officials have decided to give an extra payment to managed-care plans to cover the unexpected cost of a new treatment for a common viral illness, Hepatitis C.

The Agency for Health Care Administration intends to make a "kick payment" to plans to help them cover the drug Sovaldi, Press Secretary Shelisha Coleman said. That's the term used when an agency gives additional payments beyond the contracted amount because of unforeseen circumstances.

(Editor's note: This article contains two corrections.)

Florida's Medicaid agency has set up guidelines for use of hepatitis C drugs that will limit their required use to only the most severe cases, sparing health plans from some expense during the rollout of the Statewide Managed Assistance Program.

Special-Needs Kids in Quandary

May 9, 2014
Flickr.com by slava

Florida pediatricians say they are worried 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 traditional system -- in which doctors and hospitals bill the state whenever a patient receives a service --to prepaid health plans. Thanks to a 2011 law revamping Medicaid, Children’s Medical Services must make the transition to managed care by Aug. 1.

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