Newspaper article Sarasota Herald Tribune

AHCA's Hands-Off Attitude

Newspaper article Sarasota Herald Tribune

AHCA's Hands-Off Attitude

Article excerpt

Patients deserve protections in contract dispute

As a contract dispute between Sarasota County's largest Medicaid insurer and Sarasota Memorial Hospital nears a Dec. 31 deadline, the state's hands-off attitude is both puzzling and troubling.

Under Florida's new Medicaid privatization model, the state pays private insurers a set fee to cover its 3 million Medicaid recipients. The insurers have broad authority to determine patient care, including the ability to decide which doctors and hospitals will be part of their networks.

Still, as Herald-Tribune reporter Maggie Clark has noted, federal law requires states "to ensure that Medicaid enrollees have adequate access to care within a reasonable distance." Florida's Agency for Health Care Administration, which oversees Medicaid, has a responsibility to make that determination.

The agency's refusal in this case to take on that responsibility has impacted not only the region's only public hospital and local doctors, but the future health care of thousands of residents.

The AHCA has been largely silent on the decision by Staywell Wellcare -- which insures more than half of Sarasota County's 16,000- plus Medicaid recipients -- to terminate its contract with Sarasota Memorial, which provides hospital care for 90 percent of Southwest Florida's enrollees in the state-federal program.

No new contract

Staywell has informed Sarasota Memorial, local doctors and Medicaid recipients that it intends to end its relationship with the hospital as of midnight Dec. 31.

The insurer cited the hospital's decision to cut ties with BayCare, a third-party company that negotiated the contract on Memorial's behalf. Staywell wants a new agreement that would reduce reimbursement rates, but negotiations with Memorial to this point have failed.

If Staywell does cancel the contract, patients receiving treatment through the hospital would suffer no immediate effect.

Staywell enrollees undergoing an "active course" of treatment at Memorial would continue to receive services for at least 60 days after the contract ends, the insurer stated in a letter to patients. Pregnant women with Staywell policies who are receiving prenatal care can deliver their babies at Memorial and obtain postpartum care there. …

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