Medicaid

A study about the impact of the 2008 Oregon Medicaid expansion on hospital emergency department visits doesn’t actually tell us much about the Affordable Care Act, consultant Paul Gionfriddo writes at his website, Our Health Policy Matters. Gionfriddo details why he thinks the study is more history than news.

Miami-Dade County, the juiciest plum in Florida Medicaid’s switch to mandatory managed care, could still be in play following a ruling against the Agency for Health Care Administration in its contracting decisions. Hundreds of millions of dollars could ride on the outcome. 

The decision by Administrative Law Judge John Van Laningham, issued Jan. 2 tells AHCA that it should rescind its decision to award a contract to Prestige Health Choice for the region that encompasses Dade and Monroe counties.

healthcare.gov

About 35,000 Floridians who found they were eligible for health coverage through Medicaid are still waiting for confirmation that they’re covered, Kaiser Health News reports.

The Associated Press

Florida’s Medicaid program says it is providing free flu shots to as many as 75,000 additional pregnant women this season.

The state did away with fees late last week for 65,000 to 75,000 adult women enrolled in the Medicaid program, Michelle Dahnke, spokeswoman for the Agency for Health Care Administration, told Health News Florida.

Miami Herald

A state agency’s proposal to eliminate the state’s prepaid dental health plan for low-income children has garnered opposition from two Miami-Dade lawmakers and a coalition of dentists.  The Agency for Health Care Administration has proposed switching children’s dental services from the prepaid dental plan to a Medicaid managed care model, the Miami Herald reports. 

AP

Gov. Rick Scott, who is running for re-election, chose not to answer questions Wednesday about whether he still supports Medicaid expansion -- for which the federal government has offered Florida $51 billion over the next decade as part of the Affordable Care Act.

Getting people to sign up for health insurance under the Affordable Care Act remains an uphill battle in much of Florida.

Politicians in the state erected roadblocks to the law from the beginning — from joining in the 2010 lawsuit to thwart the law to placing restrictions on what insurance helpers called navigators can tell people seeking advice.

People filling out insurance applications on the federal marketplace may learn they're eligible for Medicaid and their information is being sent to state officials to sign them up. However, states are getting unusable information because of technical problems that continue to plague the website.

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.

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