Newspaper article The Florida Times Union

MEDICAID REFORM; the Glitch Factor

Newspaper article The Florida Times Union

MEDICAID REFORM; the Glitch Factor

Article excerpt

SECOND OF SIX PARTS

Under a pilot program that started last year, Medicaid recipients in Duval and Broward counties have been leaving the old "pay for service" method of health care and enrolling in "managed care" plans provided by private companies.

About 110,000 are on Medicaid in Duval County, 175,000 in Broward.

A second phase began this month in Baker, Clay and Nassau counties.

If Tara O'Rourke hates the Medicaid reform pilot program, who could blame her?

The Duval County woman, according to a letter from Florida Legal Services to state Medicaid officials, "was auto-enrolled in a reform plan without notice."

"Ms. O'Rourke first learned of her change in coverage when her doctor advised her that he could no longer treat her.

"When she tried to receive care and services from a provider in her new plan, she was told she was not enrolled in any plan. ...

"While she attempted to deal with this administrative nightmare, she was forced to go without care for a month - a dangerous thing for a person with her terminal illness."

That wasn't supposed to happen. The Agency for Health Care Administration seemingly had a foolproof plan to transition Medicaid recipients from "fee for service" to managed care.

Duval County recipients would get to pick among five plans. In Broward County, they would have more than a dozen choices.

Packages explaining the options would be sent far in advance.

Then, dozens of "choice counselors" would be available, on the phone and in person, to help people find the best plan for them.

If people did not choose, a plan would be picked for them - with the option to switch if they didn't like it.

That sounds easy enough. But it didn't work very well for O'Rourke. Or, apparently, for some others.

Any time large numbers of people are moved from something simple to something more complex, it won't be a perfectly smooth transition.

However, there is room for improvement as the reforms slowly spread across the rest of the state.

For example, local Legal Aid attorney Sara Sullivan says some companies don't tell people all of the drugs that are covered until after they join the plan - at which point the information is a little late to be useful. …

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