Medicaid

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.

Indian River Medical Center in Vero Beach announced Thursday it was laying off 39 employees, trimming benefits and taking other actions to reduce expenses by $10 million, according to a memo from top  hospital officials obtained by Health News Florida.

“We must become more efficient,” stated the memo, from President and CEO Jeffrey L. Susi and Dan Janicak, chief financial and operating officer.

Florida has the second-highest rate of uninsured adults under 65 in the nation, second only to Texas, the Naples Daily News reports. U.S. Census figures from 2011 show nearly 25 percent of Floridians under 65 don’t have health insurance -- a total of about 3.8 million residents, the Miami Herald reports.

Bob Mack / Florida Times-Union

In 2000, an organization made plans to build a clinic to bring care to the medically underserved in Jacksonville.  Since then, lawmakers have handed over $900,000 to Northwest Quadrant Community Health Center, but the building wasn't completed. 

At least eight Florida Republicans in the U.S. House of Representatives have called for "defunding" the Affordable Care Act during budget talks in September, according to a list on a conservative blog.

Nine Florida Republican Representatives were still listed as holdouts on the Americans for Limited Government website as of Friday morning.

Lottie Watts / WUSF

When the new online health insurance marketplace opens Oct. 1, millions of people will be able to buy insurance at the click of a mouse. The federal government has a website and a hotline people can call for help. But they'll also have people who can help face-to-face. They're called "navigators."

During a stop at the USF Tampa campus last week, U.S. Health and Human Services Secretary Kathleen Sebelius said "navigators" will assist many people who have never been enrolled in a health plan before. 


Transcript

DAVID GREENE, HOST:

This is MORNING EDITION, from NPR News. Good morning. I'm David Greene.

RENEE MONTAGNE, HOST:

And I'm Renee Montagne.

Two years ago, Dorothy Holmes, then 75, was in the cozy pink bathroom of her home getting ready to shower when she fell. It's the type of accident that's common among older Americans — and it's often the very thing that triggers the end of independence.

"I got a big spot on my head; it almost conked me out," Holmes says in her soft voice.

She heard her husband come down the hall, "and when he turned the corner all I heard was, 'Oh God, honey, what did you do now?' After that I don't know anything 'cause I passed out," Holmes recalls.

The newest wave in health care may be as close as your computer.  More hospitals and doctors are using technology, such as Skype, to treat patients, the South Florida Sun-Sentinel reports.  This can benefit patients who live too far from needed specialists, as well as allowing doctors to consult colleagues when dealing with complex cases.

Tampa-based WellCare Health Plans exceeded expectations on Wall Street for the second quarter, the Associated Press reports.

On Wednesday, White House officials pointed out several ways that Floridians will benefit from Obamacare as part of an effort to convince the Florida Legislature to accept federal money to expand Medicaid coverage, the Orlando Sentinel reports.

diabetes.org

About 45,000 low-income working parents in Florida will lose their Medicaid coverage at the end of this year and become uninsured unless they quit their jobs, a coalition of children's advocacy groups says.

KidsWell Florida says this is the surprising and unintended result of a change in the income-calculation system for Medicaid combined with the Florida Legislature's refusal to expand the insurance program for the poor under the Affordable Care Act.

Federal health officials will enact strict moratoriums on certain types of Medicare and Medicaid providers in the Miami area, Medical Daily reports. The stronger bans start Tuesday, and will affect new home health providers looking to join the programs.

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