Kaiser Daily Health Policy Report Highlights Medicaid News in Florida, New York

Summaries of news about Medicaid developments in Florida and New York appear below.

• Florida: Broward County, Fla., commissioners on Tuesday sent the state Legislature a resolution stating that the county wants to end its participation in a Medicaid pilot program that some say has led to delays in access to care, the South Florida Sun-Sentinel reports (Wyman, South Florida Sun-Sentinel, 2/25). 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. An Associated Press analysis indicated that physicians are dropping out of the program and there is little evidence to show that the program saves money (Kaiser Daily Health Policy Report, 2/6). State Rep. Elaine Schwartz (D), who worked with Broward County commissioners to draft the resolution, said two years after the pilot program began, residents "tell these terrible stories about how their medical treatment is so compromised that it is unacceptable." She added, "The HMOs are taking too much in administrative fees. There isn't enough money in the pot to make any money so the care is compromised. The physicians are dropping out. The drug formulas are a nightmare. People can't get medical care." The resolution supports repealing the program in Broward County and opposes expanding it into other counties (Kennedy, AP/Miami Herald, 2/24). State officials have said that 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, according to the Sun-Sentinel (South Florida Sun-Sentinel, 2/25). The state Agency for Health Care Administration in an e-mail to the AP wrote, "The Florida Legislature can take whatever action they deem appropriate," adding, "AHCA will continue to evaluate all components of the pilot and make appropriate revisions to ensure access to medical services for Medicaid beneficiaries" (Miami Herald, 2/24).
  
  
• New York: Daunting paperwork and the annual recertification process are among the reasons more than one-third of New York state residents enrolled in Medicaid and other public health insurance programs lose their coverage even though they remain eligible, according to a study by the New York State Health Foundation, the New York Times reports. For the study, researchers used information gathered from 60 state residents during eight focus group meetings in November and December 2008 in Albany, Buffalo and New York City. The study aimed to determine why eligible beneficiaries were dropping their health coverage. The residents -- who were former beneficiaries of the state's Family Health Plus, Child Health Plus and Medicaid programs -- said the three programs were essential and they wanted to remain enrolled. The study found that many of the residents in the focus groups said they lost coverage because the re-enrollment requirements were daunting. Residents who have been enrolled in the programs are sent a recertification application after nine or 10 months of active participation that they must complete and return to the state and at least one reminder notice. Some of the residents said they did not receive reminder notices or they received the applications after the deadline to submit it had expired. Other residents said they learned that they no longer were covered when they went to see a physician or when they were recruited for the study. According to the study, so-called "churning," in which residents lose coverage and then reapply to the programs, costs the state money because it is more inefficient. David Sandman, senior vice president of the state health foundation, said, "We've tried to open the front door as wide as possible to these programs, [a]nd now we need to focus just as much attention on closing the back door to make sure eligible people stay enrolled." The state has begun work on a new enrollment center that would allow beneficiaries to extend their coverage over the phone. Deborah Bachrach, deputy commissioner of the state Office of Health Insurance Programs, said that a new version of the paper application could be introduced as early as October (Bosman, New York Times, 2/25).
  
  The study is available online.