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Florida’s Medicaid meltdown deserves a deeper look

Florida’s Medicaid meltdown deserves a deeper look

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Parents of children enrolled in Florida’s Medicaid system were so fed up that they sued the state for denying care. Parents were waiting weeks and driving hours to find doctors who would accept their children. It’s no surprise.

Only one in three children in Florida’s Medicaid system receive adequate preventive care, and eight out of 10 children receive no dental care at all, a federal judge recently affirmed.

Florida ranks 50th out of 51 states and Washington, D.C. in per-child spending on Medicaid coverage. Florida spends just $1,707 per child per year, about one third of the amount that top-spending states allocate.

Litigation between the parents and the state is ongoing. However, Florida’s health agencies argue that much has changed since the suit was filed 10 years ago. They say the new Medicaid managed care system, rolled out for 1.8 million children in the summer of 2014, provides coverage choices for patients — 14 insurance companies offer Florida Medicaid coverage — and creates efficiency in a program that consistently eats up nearly one-sixth of the state budget.

But doctors, parents and child advocates tell a different story. Children are waiting longer for care and pediatricians and specialists are closing their doors due to extremely low reimbursement rates from insurance companies. Even though all children on Medicaid also have dental insurance, many parents and doctors view the coverage as useless.

On the political front, debates on whether to accept federal dollars to expand Medicaid coverage nearly shut down the state government this year. But missing from the discussion was the practical reality of what’s happening in the current Medicaid system, and whether the system is ready to take on the 800,000 additional people who would be covered if Florida were to expand Medicaid.

The stories of vulnerable children and families navigating the Medicaid system will anchor my National Health Journalism Fellowship project, in which I’ll explore the move to statewide managed care and its consequences for health and for Florida taxpayers.

To tell this story in the Sarasota Herald-Tribune, I will use state and federal data on child hospitalization rates, insurance enrollment volumes, wait times, arbitration between patients and insurers, and insurance plan performance metrics, among other data. Court documents and evidence from the ongoing federal court case will also feature prominently, alongside interviews with physicians, policy experts, regulators and politicians.

In addition to educating readers about the Medicaid system, we’ll illustrate why it matters for all Floridians. By nickel-and-diming preventive care for children, Florida is setting itself up for ballooning health care costs in the future. Those costs could limit the economic growth and health of the entire state.

By reporting on the Medicaid system as it stands today, we hope to inform discussion about the future of the program, both for lawmakers as they consider whether to accept federal money to expand Medicaid coverage, and for the children and families who continue to rely on the Medicaid system for their health care.

[Photo by Mark via Flickr.]

Comments

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Here is a letter, representing years of gaming with the life of a patient experience serious neglect. Thank you for your reporting I would appreciate connection to your media links....thank you for this humanitarian work..

To those responsible with Medicaid State & Federal standards.

This is a follow up of numerous earlier complaints and requests for life essential lung transplant w/cystic fibrosis medical care. As frequently stated, within appeals, care was disrupted during the beneficiary's illness.

Responding timely to the beneficiary and the "Gift of Life" has been woefully neglected and pose immediate jeopardy to beneficiaries health and safety.

This added cry for urgent care of life must be provided within the standards of Medicaid and Medicare's Conditions of Participation.

Delay of care places the patient in jeopardy with rejection, flu and additional co morbidities!

This delayed lack of resolve threatens and causes daily jeopardy of beneficiaries life. Sadly, "lack of engagement" with earlier complaints aggregates jeopardy of the beneficiary's life. Please assure this is accorded diligence with trustworthy experienced representatives. Let us all be accountable to duty and respect of life!

Immediate care, will be encouraging to the beneficiary. A collaborative transparency compliance within time standards and fair hearing with w/Federal standards is the only reasonable expectation for the conduct of all involved.

First is restored care!

Respectfully and cordially presented; herein, for the benefit of all parties as the law and code obligates.

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