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Physicians Unhappy With Managed Medicaid System, Report Finds

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Georgetown University
The Florida Channel
Joan Alker.

Since 2014, Florida’s Medicaid program has been run not by the state but through private insurance companies. The Sarasota Herald-Tribune has written about problems with the managed care system and a recent report from Georgetown Universitysurveyed pediatricians to determine how they feel about the system.

Health News Florida Editor Julio Ochoa sat down with one of the report’s authors, Joan Alker, executive director of the Center for Children and Families at Georgetown University. 

Julio Ochoa: In the report, two-thirds of pediatricians noted issues that kept them from providing children with care. What were some of the road blocks?

Joan Alker: One of the problems that we heard from pediatricians is that they've seen an increase in families whose children have been assigned to a different managed care plan or a different doctor without their knowledge. So that means when they come in for a visit they may not have the same insurance that they used to have; the doctor may no longer be on their list. So that's very frustrating for doctors and patients alike. The doctor's office has to spend time helping them to switch plans or switch primary care doctors.

JO: The study also found that doctors are having problems connecting kids with specialists who accept Medicaid. In what areas is this a serious problem?

JA: By far the No. 1 specialist that was cited as a problem to refer Medicaid kids to was mental health and behavioral health professionals. That is really a problem because we know that kids on Medicaid have higher incidences of behavioral health conditions like anxiety depression autism and attention deficit disorder. The state needs to pay a lot more attention to the need for good behavioral health services that are available to these kids.

JO: Why aren't they accepting Medicaid?

JA: Well I think there's just too many kids who need services and too few doctors who are able to see them period. We know this can be a problem for kids with private insurance as well. We don't have that many mental health professionals that specialize in kids as opposed to adults. But having said that, I would imagine the reimbursement rates are very low and that's one of the deterrents, plus these kids tend to have higher needs.

JO: It's clear that pediatricians are frustrated. What about families? Can they take something from this report in terms of the child's health care?

JA: The important lessons for families is when you go to your pediatrician's office, really try to work with them to ensure that you are on a plan that has access to the doctors that your child has been seeing. Families do have a choice of plans in most areas and they can take a look with their doctor at the list of providers that are associated with each plan.

JO: How many states operate Medicaid through managed care and how does Florida stack up against them?

JA: So, the majority of states do operate Medicaid through managed care, at least some portion of their program. There's only a handful that don't and they tend to be pretty rural states. One of the things we looked at in this report was some national quality indicators for kids and what we found is that Florida has done a good job of reporting on those indicators but their performance compared to other states reporting is not great. For example, children are not getting as many well-child visits and they're not seeing the doctor as often as they are in some other places. Another area where Florida is doing extremely poorly is dental care.

JO: These findings are the result of policies the state implemented in the past few years. Given the report, what changes can be made to improve the situation?

JA: The state needs to be doing a more aggressive job with oversight of these plans, holding them accountable for their services that the taxpayer dollars are buying for these kids and that's where I think we need to see more transparency, more accountability and more rigorous evaluation to make sure kids are getting the services they need.

JO: Is there anything else a Floridians should be concerned about?

JA: Overall Medicaid and the Children's Health Insurance Program nationwide has done a great job bringing the number of uninsured kids down nationwide to only 6 percent. And Florida has improved as well. Florida has seen considerable drops. But their uninsured rate is 9.3 percent so quite a bit higher than the national average and it has the highest rate in the South, which I think it comes as a surprise to many people. We do know that Latino children have higher uninsured rates. You obviously have a large Latino population here in Florida. But it also reflects state policy choices. The state could make it easier for kids to enroll and they could also make it easier for kids to stay on so they don't fall off by mistake and those are the kinds of policies the state needs to look at.


Julio Ochoa is editor of Health News Florida.