Newspaper article The Florida Times Union

MEDICAID REFORM; Transitional Pains

Newspaper article The Florida Times Union

MEDICAID REFORM; Transitional Pains

Article excerpt


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 for Baker, Clay and Nassau counties.

Nobody expected Medicaid to have a perfectly smooth transition from "pay for service" to managed care.

But neither did anybody think it would turn deadly. Yet, apparently, it did.

Luisa Guerrero was six weeks pregnant when she sought assistance in Duval County, according to a letter written to state Medicaid officials by Legal Services attorneys in Miami.

Snared in bureaucratic red tape, she went without prenatal care for some time as she was shuffled around from one doctor to another, and one plan to another.

Eventually, the attorneys allege, she "was admitted to the hospital with preterm labor, where she delivered ... Her daughter, who was too little to survive, died several days later."

That's tragic beyond words. Hopefully, the confusion will fade away as people settle into plans.

There also are complaints about providers substituting less-expensive drugs, sometimes even generic brands.

Does that matter? Sometimes, maybe. Most of the time, probably not.

A generic, the Food and Drug Administration's Web site says, is "the same as a brand-name drug in dosage, safety, strength, how it is taken, quality, performance and intended use. ...

"They have the same risks and benefits as their brand-name counterparts. ..."

Then, why do they look different?

"Trademark laws do not allow a generic drug to look exactly like the brand-name drug," the FDA explains.

"A generic drug must duplicate the active ingredient. …

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