MIAMI (AP) - State health officials are moving tens of thousands of Medicaid patients with serious medical conditions into managed care plans, but health care plans are worried the patients won't be able to afford the proposed monthly premiums which could lead to lapses in care.
The state pays the monthly medical bills of patients with high health care costs under the Medically Needy program even if they make too much money to normally qualify for Medicaid. Patients must meet a share of cost each month that varies based on their income.
The state spends more than $900 million a year to provide services for at least one month to more than 250,000 people a year. But under a new Medicaid privatization plan, the state is asking those patients to start paying roughly $120 a month to receive services. If they can't pay, they are kicked out of the program after a 90 day grace period and have to go through the red-tape of re-qualifying. Advocates worry the change could lead to lapses in care in care for a population with serious chronic health conditions such as cancer, heart disease and HIV.
At a public meeting on the issue in South Florida this month, representatives from health care plans warned patients won't be able to pay the proposed $120 monthly costs in a downturned economy, leaving health care plans on the hook.
"We believe there's going to be a high incident of non-payment," said Michael Garner, president of Florida Association of Health Plans, Inc.
Health plans estimate it could cost them $97.8 million a year to cover patients who can't pay but are still receiving services during that 90-day period.
"We're going to ask you to pay premiums every month and if you don't, you're going to lose your coverage ... we're talking about transplant patients, patients with HIV AIDS, Cystic Fibrosis, patients with very serious health conditions and a single month gap could lead to very serious consequences," Garner said.
It will be the first time private health care plans in the state will provide coverage for medically needy patients and experts say it's a difficult and expensive population to cover because they have serious health conditions and often have low incomes. It's more profitable for health plans to cover a healthier population but state officials mandated that plans must cover medically needy patients in addition to the general Medicaid populations in order to prevent them from cherry picking patient populations.
Plans said they don't currently have the infrastructure, including collection services and rate figures, to serve the population.
State officials declined comment on concerns about lapses in care for non-payment, and referred to a link on their website that outlined the process for payment and nonpayment.
The change comes as Florida is overhauling its Medicaid program, putting care of nearly 3 million patients into private managed care plans. Gov. Rick Scott signed legislation last year that allows the state to pay for-profit providers a set amount for each patient per month and the provider will decide what medical treatments and services are appropriate. But the state has been waiting more than a year for federal health officials to sign off on the plan.
That legislation also allowed changes to the Medically Needy program, including the proposed monthly fee. Currently, eligibility is determined every month, but under the proposed changes, patients who qualify and pay the monthly premium will have 12 months of continuous enrollment which officials say will improve access to medical services.
But health care plan executives said the rates the state wants to pay them to care for patients is far too low. That means the plans are already paying more money to cover the patient, plus incurring the burden of trying to collect a monthly fee and covering those that don't pay for 90 days.
"That puts the health plans deeper into the hole," said Marc Love, a vice president for a health care company that covers HIV and AIDS patients.
Positive Healthcare Florida serves roughly 200 Medicaid patients with HIV and AIDS in South Florida. Love wants the state to come up with another option that doesn't charge patients a monthly fee.
He said their regular Medicaid patients already struggle with a co-pay to cover their medications now and they aren't required to pay a monthly fee.
"It's part of our mission to care for these individuals ... this is a very needy population so it's part of our mission to make sure they have the access to the care they need at the right price," Love said.
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