Medicaid Reform Progress Report

Barbara Miracle | 9/1/2007

But one of the biggest complaints about Medicaid reform also involves choice counseling — specifically, the counselors’ lack of information on drug benefits. “Not knowing which plans cover which drugs is a major problem,” says Leone. Counselors now ask upfront if beneficiaries have a chronic illness, disabilities or conditions that require multiple medications and connect them with a special needs counseling center.

Perhaps the biggest question mark about Medicaid reform has to do with whether enough doctors will participate. Data so far are contradictory.

This spring, the Georgetown University Health Policy Institute (working under contract with the Jacksonville-based Jesse Ball duPont Fund) surveyed members of the Broward County Medical Association and the Duval County Medical Society and found that 27% of 141 responding physicians who previously participated in Medicaid didn’t intend to participate in any of the new Medicaid reform plans. Among that group, two-thirds were specialists — a key target in the reform.

It’s unclear whether the report reflects physicians’ antagonism toward the reform plan or toward Medicaid reimbursement rates in general. Arnold argues the Georgetown study is “fundamentally flawed.” His own study — an AHCA survey in March — showed that 97% of Broward primary care physicians who participated in Medicaid before reform are participating in reform. In Duval, the figure is 98%, he says.

Bob Wychulis, president and CEO of the Florida Association of Health Plans, which represents HMOs but not PCNs, says, “Access to specialists and subspecialists is excellent in Medicaid HMOs.” Florida Medicaid, he adds, had been using managed care plans long before the pilot programs. Indeed, Florida’s fee-for-service, or indemnity, plan was on its way out before Medicaid reform came along. As of June 30, 2006, 65% of Florida’s Medicaid beneficiaries statewide received their benefits through managed care, according to the Kaiser Family Foundation’s StateHealthFacts.org.

“Doctors proportionate to their experience are way undercompensated. There’s absolutely no incentive for them to join these plans.” — Dr. Arthur Palamara, vascular surgeon and former vice president of the Florida Medical Association [Photo: Eileen Escarda]

But problems remain with specialists, particularly endocrinologists and dentists, says Sarah Sullivan, senior staff attorney for the Medicaid Reform Project of the Jacksonville Area Legal Aid. She explains that one of the HMOs, Wellcare’s HealthEase, does not include endocrinologists — vital specialists for those with diabetes. The HMO will find an endocrinologist and pay for the service separately, but Sullivan says that beneficiaries must get prior authorization before every visit.

Tags: North Central, Healthcare