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State Medicaid changes come under fire

TALLAHASSEE, Fla. – Florida has put in place sweeping changes to its main health-care safety net program over the last several months, but legislators on Tuesday received an earful about ongoing problems with the $28 billion Medicaid program.

Some of the changes include new five-year Medicaid contracts with managed-care plans, as well as changes in payments to behavioral analysis providers who treat children with autism.

While top-ranking Agency for Health Care Administration officials have touted the moves as improvements, members of the Senate Health Policy Committee on Tuesday heard testimony from caregivers and providers who complained that they aren’t getting paid.

Tampa resident Ruth Benson is a foster parent of two medically complex children. She is one of 348 medical foster parents across the state.

Benson receives $475 per week per child to help pay for care. But she hasn’t been paid since Jan. 1, which is when Florida transitioned to new Medicaid managed-care plans in Tampa.

Benson acknowledged that the state has held informational webinars on the Medicaid changes but said they were scheduled for noon on Fridays, which isn’t a convenient time for people with children.

“On Fridays, I have seven therapies that I start at 7:30 in the morning,” Benson said, adding, “It’s just extremely frustrating to go through this and not get paid.”

Pensacola resident Merrie Schwartz has been a foster parent for 30 years and in that time has seen many changes to the program. But Schwartz, who has five medically complex foster children, said the switch to managed care is unlike any other change in the past and that it has put a large burden on her and other caregivers.

Like a large pharmacy group or doctors’ office, Schwartz has to be “credentialed” to be part of a Medicaid HMO managed-care network.

“We don’t even understand what credentialing is,” she said.

Florida lawmakers in 2011 approved an overhaul of the Medicaid system that included requiring most beneficiaries to enroll in managed-care plans. That was followed by an initial set of contracts with HMOs and other types of plans.

The Agency for Health Care Administration during the past year has finished a new procurement process. Ultimately, AHCA signed new five-year contracts --- which state officials once said were worth at least $90 billion in all --- with more than a dozen different plans.

The state has rolled out those new Medicaid managed care plans in phases, transitioning eight Southeast Florida counties, including heavily populated Miami-Dade and Broward in December. A timeline included adding 18 Central Florida counties in January and the remaining 41 counties in February.

Tuesday’s testimony at the Senate Health Policy Committee was met with bipartisan concern.

Sen Dennis Baxley, R-Ocala, said the state before implementation had not done a good job of communicating the changes with providers or affected people.

“If you never see the people, you never see the client, there is never a rapport, somebody has to serve that role of onboarding. Otherwise, you immediately lose most of the essential personnel that you must have to run that business,” he said. “If you can work out that communication system, you have solved more than half of what’s been brought here.”

Sen. Janet Cruz, who referred to foster parents as angels, said people traveled to Tallahassee to “beg” the Legislature for help.

“The onus is on us,” said Cruz, D-Tampa. “What are we going to do here?”

The committee also focused on other Medicaid providers. For a second time, it discussed AHCA’s decision to freeze payments to behavioral analysis providers who treat children with autism as the state finalized anti-fraud measures.

Medicaid director Beth Kidder told members of the committee that Medicaid now spends $48 million a month for 11,000 people ages 21 and under who qualify for the services.

There are four different levels of behavioral analysis providers in Florida: billing group, lead analyst, associate analyst and registered technician. The state required registered technicians to meet certain requirements by Jan. 1 as a way to ferret out fraud. It also froze payments to providers as it conducted a review.

Monique Todd provides behavioral analysis services to children in Titusville, Ocala and Melbourne and said registered technicians worked to meet the new certification requirements and submitted the required paperwork.

But Todd said the state was inconsistent in what it allowed behavioral analysis technicians to include as part of the credentialing requirements. As a result, Todd said, the state has moved to recoup more than $100,000 in Medicaid payments for services that were provided. The state assesses a 20 percent charge on any challenge, so it would cost Todd $25,000 to challenge the move.