WELLCARE HEALTH PLANS INC., Florida's largest Medicaid HMO contractor, will end its participation in the state's troubled
Medicaid Reform pilot program in Duval and Broward counties, effective July 1.
Sources of Coverage, 2006-2007
|
WellCare said its decision to leave the pilot program in the two counties, where it was the dominant provider, came as a result
of the state's budget cuts, which made operating the program economically unfeasible. The company's withdrawal there affects
more than 78,000 beneficiaries.
The development, announced in February, was the latest snag for a Medicaid privatization program that has struggled during
the past year. Under the pilot program, which covers most Medicaid beneficiaries in five Florida counties, the state pays
private insurers a set amount for covering a specific number of residents and the companies determine what benefits and coverage
network they will offer.
But the program has been plagued by problems. In October, federal authorities accused employees at Tampa-based WellCare of
scheming to defraud Florida's health agencies of more than $20 million, according to the Tampa Tribune. An Associated Press analysis published in The Miami Herald states "doctors are dropping out of the program, and there is little evidence the program is saving money."
Consumers have filed lawsuits as well. In November the state Agency for Health Care Administration (AHCA), which administers
the program, settled a class action suit by promising to alert some Medicaid beneficiaries about their rights to disenroll
from their HMOs for "good cause."
Critics of the pilot project say the state should end the program or at least abandon plans to expand it. In February, Broward
county commissioners sent the state legislature a resolution stating that the county wants to end its participation in the
pilot.
FLORIDA
|
State officials say the program is effective and should continue because it has increased the number of health plans available,
allows beneficiaries to customize their care and provides services not previously covered by Medicaid.
CARE ACCESS
Eight million state residents—nearly half of them among the uninsured—lack access to a regular source of primary healthcare
in Florida, according to a report by George Washington University. More screenings and preventive care could reduce emergency
department visits, and greater access to primary care could generate $700 million in savings annually for the state. The Florida
Association of Community Health Centers plans to use the study to support its call to the state legislature for increasing
funding for community health centers and public clinics from $15.3 million to $31 million in 2010, according to the Miami Herald.
FLORIDA NURSING HOMES TO BE TAXED
In January, Florida Gov. Charlie Crist signed legislation that places a 5% tax on nursing homes' net revenues as a way to
increase the matching federal funds they receive through Medicaid. The tax is expected to draw down 55 cents in federal Medicaid
funds for every 45 cents it generates.
Nursing homes began collecting the money on April 1 under the assumption that the Centers for Medicare and Medicaid Services
will approve a Medicaid waiver that will allow the matching funds to be allocated.
According to the Florida Health Care Assn., without the tax, nursing homes faced a scheduled 10.5% cut in Medicaid funding,
or more than $231 million.
IMMIGRATION DETENTION CENTERS
The Immigration and Customs Enforcement (ICE) agency routinely delays or denies medical care for detained immigrants, or provides
low-quality care in ill-equipped facilities nationwide, according to two reports released in March by Human Rights Watch and
the Florida Immigrant Advocacy Center.
The advocacy groups believe many of the medical problems could be avoided if ICE did not detain people who are elderly, have
health problems or those who do not have criminal records. Advocates say that alternatives to detention, such as requiring
immigrants to check in by phone or in person, could cost as little as $12 per day, compared with detention, which costs about
$95 per day.
MHE Sources: Centers for Medicare & Medicaid Services; Urban Institute; Kaiser Family Foundation; U.S. Census Bureau; The
Commonwealth Fund.
