Medicaid

Yoselis Ramos / WUSF

If you weren't looking for it, you might miss it, sitting between a nail salon and a discount grocery store in a shopping plaza that seems to have an endless parking lot. Tucked in the plaza is a multi-million dollar medical clinic. 

"The model is all inclusive, where you can come and get everything taken care of in one place," said Mark Kent, CEO of CAC-Florida Medical Centers, a subsidiary of health insurance giant Humana.

Even though Florida’s Legislature turned down federal funds to expand Medicaid under the Affordable Care Act, leaving billions of federal dollars on the table, the state's health insurance program for the poor continues to grow.

State Sen. Joe Negron, R-Negron, said he doesn’t expect there to be any movement on the issue of Medicaid expansion during the upcoming session, the Florida Current reports. Negron, who chairs the Senate Appropriations committee, tried last session to pass a private-sector version of Medicaid expansion that accepted federal money to cover the low-income uninsured.

A University of Florida College of Pharmacy professor is looking at the potentially harmful combination of psychotropic drugs used to treat children on the state’s Medicaid program.

A South Florida company that unsuccessfully bid for Medicaid managed care contracts is questioning how a company with financial ties to Florida Blue ended up with contracts in eight of the 11 regions, the Florida Times-Union reports (paywall alert).

Florida has rejected an offer of more than $50 billion over 10 years from the federal government to expand Medicaid coverage under the Affordable Care Act. So the question remains: how will health care be funded for more than a million low-income Floridians? This week on Florida Matters,  a panel discussion that was held last week at Stetson University College of Law to discuss the options. It was sponsored by the Tampa Bay Healthcare Collaborative. 

A judge has ruled that a Daytona Beach hospital violated the federal Stark Law, which bars physicians from getting extra cash from patient referrals through kickbacks, split fees and other under-the-table arrangements, the Orlando Sentinel reports.

The case, scheduled to go to trial in March, stems from a 2009 lawsuit filed by whistleblower Elin Baklid-Kunz, a former compliance officer for Halifax Hospital.  Hospital officials have denied wrongdoing.

From one end of Florida to the other, calls for Florida House leaders to accept $51 billion in Affordable Care Act funds to expand Medicaid to cover the state's low-income uninsured were renewed on Wednesday. Even Gov. Scott started flirting with Obamacare again. But the man who said no to the money before -- House Speaker Will Weatherford -- is still saying no.

Here's a quick look at the action:

State Rep. Mark Pafford, the incoming leader of Florida House Democrats, says he will continue to press the issue of Medicaid expansion during the upcoming legislative session, the Florida Current reports. Republicans in the Florida House blocked  Medicaid expansion under the Affordable Care Act during the 2013 session.

Tampa-based WellCare Health Plans Inc. is planning to borrow $600 million, the Tampa Bay Business Journal reports. The company, which provides managed care services for Medicaid and Medicare health plans, will issue senior notes in a public offering.

A 40-something patient I'll call Ted has a list of conditions that would have tongue-tied Carl Sagan. Even though I see Ted in my clinic every month, he still winds up visiting the emergency room 20 times per year.

Yes, 20.

Before he became my patient, he went even more frequently. So, the current situation, bad as it may be, represents halting progress.

WellCare Health Plans is forecast to remain No. 1 in Florida Medicaid managed care enrollment next year after winning a challenge to  a state contracting decision affecting patients in northeast Florida.

According to a new report from the Wall Street firm Stifel, Nicolaus & Co., WellCare's enrollment at the completion of  the statewide Medicaid managed-care rollout will likely edge out that of Centene Corp., which does business in Florida as Sunshine State Health Plan.

WellCare

Tampa-based WellCare Health Plans, Inc. has replaced chief executive officer Alec Cunningham with chairman David Gallitano. 

A majority of physicians who responded to a Florida Medical Association survey this month said they support expanding the Medicaid program to cover more indigent and working-poor adults, FMA reported Tuesday

But that's not the group's number-one goal for the coming legislative session, so it's unclear whether FMA will lobby for it.

A report from analyst firm Stifel says Florida has added four more Medicaid managed care contracts in addition to the two insurers, Centene and WellCare, that were awarded contracts in September. 

In October, the state gave contracts to Aetna, Amerigroup, UnitedHealth and Molina.

Carol Gentry / WUSF

While most of the uninsured will be able to get subsidized health coverage Jan. 1 under the Affordable Care Act, the poorest adults under 65 will be out of luck in many states, including Florida. 

    

You could call them “The Forgotten.”  Many are women in their 50s and 60s, too old to have children still at home so they can’t qualify for Medicaid. But they’re not yet 65 so they don’t qualify for Medicare, either.

Gary Stein of Tampa, retired public health professional turned advocate for health reform, has written a column about the unfortunate stereotypes that some doctors (and others, including politicians) have about Medicaid patients.

Months after Florida House Republican leaders rejected federal money to expand health coverage for the low-income uninsured, a state agency will ask them to request money under a different Medicaid bucket to give to hospitals for charity care. 

This bucket, called the “Low Income Pool,” would be expanded from $1.4 billion a year to about $3 billion under the Agency for Health Care Administration’s proposal.

UnitedHealthcare is triggering a furor in southwest Florida by dropping 300 physicians from its AARP/Medicare Complete HMO network, according to the Fort Myers News-Press.

Some low-income Floridians who can't get Medicaid coverage now will qualify for it after Jan. 1, under new Medicaid eligibility guidelines that apply nationwide.

Savings accounts, a car and child support will no longer count against eligibility, which should make it easier for low-income parents to qualify, according to an account in the Orlando Sentinel.

More than half of Florida’s 115,000 fast-food workers receive some form of public assistance because their incomes are so low and they have few benefits, according to a study by the University of California-Berkeley. The Palm Beach Post reports the assistance, including Medicaid and food stamps, costs Florida taxpayers $348 million a year. 

Florida hospitals had strong profits last year, according to an analyst's report, and so did its HMOs, especially those that specialize in Medicare patients.

A research team that has been monitoring Florida’s “Medicaid Reform” movement for almost a decade is calling for vigilance as the last patients – those who are sickest and most at risk – are transferred into commercial HMOs.

The authors noted with approval that federal health officials have imposed some unprecedented patient-protection requirements on Florida Medicaid as a condition of granting the state’s request for a  waiver of the usual rules.

Sebelius to Visit Tampa Amid Obamacare Web Delays

Oct 8, 2013

The Obama administration promised "significant improvements" in accessing the federal health overhaul website this week, after taking down the system for maintenance over the weekend. But many in Florida were still unable to enroll at the start of week two. 

There were so many important health stories this week -- mostly about policy and politics -- that we want to make sure you didn’t miss any. The newest development this morning is a vote by the Republican-controlled House to fund the government but eliminate funding for the Affordable Care Act. Here’s a roundup of the best stories from the week: 

Law May Rescue Patients from Paperwork

Sep 18, 2013
Bruce R. Bennett/The Palm Beach Post

The disease Greg Eisenstein endures is described as more painful than childbirth or even amputation in the medical literature. The state of Florida, Eisenstein says, is making him worse. (Editor's note: This story has been reprinted with permission from the Palm Beach Post.)

At a community center named for Florida civil rights pioneer Carrie Meek, a few dozen members of Miami's National Church of God gathered over the weekend for a tea party — and to hear from a special guest, Monica Rodriguez of Enroll America.

The organization is working to spread the word about the Affordable Care Act, the federal law that will let people without health insurance shop for coverage starting Oct. 1.

A Pembroke Pines chiropractor who was allowed to keep practicing after pleading guilty in the 1980s to defrauding insurance companies is in trouble again, the South Florida Sun-Sentinel reports. This time, David Hirschenson is accused of illegally chasing down accident victims to offer them medical services.

An unintended coverage gap in the Affordable Care Act will leave nearly 1 million low-income Floridians unable to obtain health insurance when the federal Marketplace opens Oct. 1, according to consumer group Families USA.  The gap was created when the Florida House refused to accept federal funds for Medicaid expansion -- a decision left up to the states by the Supreme Court’s ruling in June 2012.

WellCare Health Plans, with its stock already up more than 40 percent this year, announced it is buying another company on Thursday. The Tampa company stands to grow in Florida by as much as $1 billion in the Florida Medicaid conversion to managed care, to be announced Sept. 16.

About 1.7 million Medicaid enrollees will be given a choice of managed-care plans, and if WellCare maintains its current 25 percent market share, it would gain $1.1 billion in new revenue, says Stifel analyst Tom Carroll in a note to investors.

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