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Mentally ill forced into HMOs, group says

4/17/2009 © Health News Florida

Thousands of Florida Medicaid patients who were being treated in specially-designed mental health plans were recently switched without warning or consent into HMOs that removed them from their treatment and support, according to the advocacy group Florida CHAIN.

The "forced reassignments" occurred when the provider networks that included the mental-health plans, Access Health Solutions and NetPASS, were sold, according to CHAIN. They became part of two giant corporate HMOs: Molina Healthcare and Centene Corporation, through a subsidiary, Sunshine State Health Plan.

Four counties – Hillsborough, Pinellas, Pasco and Miami-Dade – have been affected so far and similar events are expected in other counties, according to Lisa Margulis Grossman, interim executive director of CHAIN.

“Many of these affected recipients are seriously emotionally disturbed children and severely mentally ill adults who specifically chose (the special plans because they) provided them with a medical home,” Grossman wrote in a letter Thursday to Holly Benson, Secretary of the Agency for Health Care Administration.

The letter, released Friday morning, says such a “backdoor expansion of HMOs” appears to violate state and federal Medicaid regulations that require patients to be be notified before such changes take place. Grossman called on Benson to make it possible for the affected patients to return to their mental-health plans.

Bob Sharpe, CEO of Florida Council for Community Mental Health, said his organization is aware of the problem and working on it. The shift "doesn't meet the requirements of the law," he said.

AHCA spokeswoman Shelisha Durden said Friday morning she would have a response soon. (Editor's note: Health News Florida will post the response as soon as it’s received.)