Newsletter Articles

In Florida, Medicaid Is a Matter of Life and Death

By: Noreen Marcus

Elder Law Associates Newsletter dated October 11, 2017

 The first thing Kristina Iavarone wants to buy when her son gets Medicaid is an asthma inhaler.

He and his sibling lost their health insurance six months ago due to family finances.
 
"They've been off health care for six months and six months is long enough," says Iavarone, a waitress in Tampa. Fortunately her son, 16, hasn't had to go to the emergency room.
 
Since the teenaged Iavarones should be able to qualify for Florida KidCare, the state's main Medicaid program for residents under 19, they shouldn't have to wait much longer.
 
The same may not be true for their 47-year-old mother, who has gone without health insurance for five years. She falls into the category of adults who can't get Medicaid even though their children can.
 
Medicaid is the health insurance program of last resort that covers 74 million low-income and disabled Americans. Jointly funded by the federal and state governments, it is run by the states and tailored to meet differing needs and policies on such things as eligibility. Participants in Florida's Medicaid program talk about its sheer uncertainty, a damning description in the insurance lexicon. Medical providers find the program cumbersome, low-paying and risky.
 
Louise Jeroslow, a Miami health care lawyer who has represented Medicaid-enrolled physicians, says they have no right to appeal when they're dropped, seemingly at random, for things like minor paperwork errors. "It's so punitive and so impactful. That's my number one gripe," Jeroslow says.
 
Hospitals facing $550 million in new state Medicaid cuts have no idea how much charity care reimbursement they'll get from a federally distributed, $1.5 billion low-income pool. The managed care initiative the Florida Legislature first approved in 2011 aggravates their Medicaid headaches.
 
"When we had straight Medicaid, where the state administered it, the hospital would file claims and get payments in seven to 10 days and there was one set of rules to follow," says Vincent Sica, CEO of DeSoto Memorial Hospital in rural Arcadia. "Now we have four private Medicaid providers and we get paid in 30 to 45 days and have four different sets of rules to follow."
 
And Medicaid's arcane requirements confuse patients. The Obamacare repeal or replace battle that just ended – or perhaps paused – in Congress, with all its threats to slash Medicaid, didn't help. A bill the House passed in May would have left an estimated 24 million Americans without insurance in a decade; one of several Senate proposals would have cut up to 32 million.
 
"The discussions of Medicaid in the broader federal health care debate have been deeply unsettling to the people who rely on the program," says AARP Florida director Jeff Johnson. "We've seen and heard this most from family caregivers whose aging relatives rely on Medicaid to provide the long-term care they need."
 
Florida Medicaid covers 4.4 million low-income children, pregnant women, adults, seniors and people with disabilities, the Kaiser Family Foundation reported in March. If the state wasn't one of 19 that rejected federal dollars for expansion, an estimated 800,000 more residents would have health insurance because all who earn up to 133 percent of the federal poverty level would be covered. Floridians in what's called the "Medicaid gap" are adults who earn too little to qualify for ACA subsidies and are ineligible for Medicaid unless they fall into a special category, such as pregnant women, parents of children under 19, seniors and certain disabled people.
 
Given the obvious need, why have the Florida Legislature and Gov. Rick Scott refused to expand Medicaid?
 
Scott said he opposed expansion because it would extend a type of welfare to adults who are able, but unwilling, to work.
 
Conservative House members said they were skeptical that promised federal dollars would come through, leaving the state with an even bigger bill. State and federal Medicaid spending in Florida totaled $21.8 billion in fiscal 2016, according to the Kaiser report.
 
Broken down into spending per full-benefit enrollee, Florida ranks at the bottom – 49th in fiscal 2014, according to information compiled by the Kaiser foundation. The state was 24th for health care overall in the most recent U.S. News ranking of Best States.
 
Former House Democratic leader Mark Pafford, who represented West Palm Beach, says the House Republicans' rationale was rooted in dislike of former President Barack Obama.
 
"Until the current situation in Washington, that had never been done, there was never any rug being pulled out from under a program like Medicaid," Pafford says. "The excuses they provided were far-fetched, not fact-based, and there was this perpetual propaganda that Medicaid was a broken system."
 
Some Medicaid applicants were left languishing in limbo too long. In February 2016, Politico Florida reported this state data: 6,538 poor, disabled, or elderly Floridians died over the course of a year while waiting for home and community services. Nearly 2,000 of them were on a waiting list for Medicaid long-term care during the 2014-2015 fiscal year.
 
Nothing came of the report except outrage from health care advocates. "This is a tragedy for this to happen as often as it's happening," AARP Florida spokesman Dave Bruns told Politico at the time.
 
Term limits ended Pafford's political career in November. In 2015 he'd taken an $85,000-a-year job running Florida CHAIN, part of a national health care advocacy nonprofit. After the November election CHAIN's main funder announced staff cuts, including Pafford. He remains on the group's board but works for the Orlando tax collector.
 
What bothers him about Medicaid politics, says Pafford, is "leaders in the state have cast away any compassion for Floridians who are living in poverty and they just don't exist in their minds. To be that inhumane, to allow things like cancer to riddle somebody's body and then get a diagnosis they're at stage four because they couldn't get a pap smear or a breast exam or a colonoscopy – --and these are basic services everybody should have access to – --to me it's sickening."
 
Medicaid matters also to middle-class patients, says Bruce Rueben, president of the Florida Hospital Association. He cites the federal law that guarantees hospital care to all, no matter their financial circumstances.
 
"When hospitals have to make changes to deal with cuts, that reduces access for everyone. You can't just choose Medicaid patients," Rueben says. "If you reduce hours or a service, that affects everyone."
 
Should concerns about Medicaid carry over to Medicare? Health care advocates are wary but fairly confident the traditional earned-benefit system will survive intact.
 
Johnson, the Florida AARP director, notes that since Medicare is federally funded and directed, it's shielded from interference by the states. Congress is another matter, as Medicare makes up a significant chunk of the federal budget, and in a Republican-dominated legislative body, it presents a large target for budget cutters.
 
"There's a sense that first they'll come for the Affordable Care Act and then they'll come for Medicare," Johnson says. Still he argues that based on AARP's internal membership polling, Americans over 50 are an energized interest group that will aggressively resist any perceived threat to their health insurance.
 
"It doesn't take much to get people focused on that topic because it is so essential to their security," Johnson says.
 
"We live in a divided political environment, but Medicare and Social Security tend to cross those lines pretty well," he says. "It's one of those pretty rare issues where you get commonality across the partisan divide."
 
Article Source: US News