Medicaid Changes Bode Ill for County; Health Providers Express Concerns

Article excerpt

Byline: MARY HURST

The county's poorest residents, who often already face the most pressing health problems, could have a difficult time getting the health care they need when Medicaid undergoes reform starting in July 2007.

While the changes wrought by that reform are more than a year away, they already concern Nassau County health-care providers serving Medicaid patients.

A recent Medicaid Reform Summit at the Yulee Full Service School brought Nassau County government, school system, nonprofit agencies and health department representatives as well as physicians and members of the Nassau County Community Alliance together with state officials with the Florida Agency for Health Care Administration and the Department of Children and Families.

AHCA is charged by Gov. Jeb Bush with implementing an integrated Medicaid reform system pilot project.

Instead of health-care providers receiving a fee for services, the state wants to go to a managed-care arrangement. The state will contract with health maintenance organizations or provider service networks that will pre-approve procedures, referrals and hospitalizations.

AHCA officials say the change will increase patient choice and save taxpayers' money. Providers would have to accept less money per service and obtain approvals for tests, procedures or referrals to subspecialists. The current Medicaid program does not require prior approvals.

A pilot program for the reforms will roll out in Duval County this July. Nassau, Baker and Clay counties will implement a similar pilot program in July 2007.

Local officials and providers say, though, that life on Medicaid is different in a large city like Jacksonville than it is in small, rural counties, like Nassau.

Under the current system, Medicaid providers in Nassau County are barely covering their costs, health-care officials say. With potentially decreased reimbursements and increased costs to handle the paperwork that comes with pre-approving procedures, it may no longer be financially worth it to some providers to treat Medicaid patients.

"I am very concerned about where Medicaid reform will take our county service delivery system. I believe that we need to have a joint meeting among the county commissioners, the executive board of the alliance and AHCA Secretary Allan Levine to discuss the options and solutions for Nassau County," Nassau County Community Alliance Chairwoman Vickie Samus said. "This is very serious and requires our full attention."

MEDICAID CHANGES

Medicaid is a state and federal partnership to provide health coverage for selected categories of people with low incomes.

Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children. How Medicaid is administered varies from state to state.

Florida implemented its Medicaid program on Jan. 1, 1970, to provide medical services to poor people. Over the years, state lawmakers authorized Medicaid reimbursement for additional services. A major expansion occurred in 1989 when the U.S. Congress mandated states provide all Medicaid services allowable under the Social Security Act to people under age 21.

Bush has implemented the Medicaid reform to curb the increasingly larger share of the state budget the program takes up.

Nassau County has a Medicaid population of 3,900. Baker County has 2,000 and and Clay County has 25,000. However, not all Medicaid patients will be covered under the reforms.

For example, mental health clients will be affected, substance abuse clients will not. Children with chronic medical conditions, persons receiving Temporary Assistance to Needy Families, some Social Security patients and HIV/AIDS patients are covered.

Children in state custody are not going to be included in the revamped Medicaid program, according to Diana Dimpirio, director of program development with the St. …