State seeks changes in medically needy program

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Florida Medicaid officials have asked the federal government to approve major changes in a program that serves tens of thousands of people with costly medical conditions, seeking to install a type of managed care and require monthly premium payments, reports Jim Saunders of the News Service of Florida.

The Agency for Health Care Administration, carrying out a 2011 law, requested changes in the state’s Medically Needy program. In a document sent to the federal government in late April, the agency said the proposed changes would improve care for beneficiaries.

“The proposed demonstration (the changes) will improve the effectiveness of the Medically Needy program by providing access for this population to an integrated service-delivery system of health care,” the document said.

But Florida CHAIN, a patients-advocacy group, blasted the proposal. It said, in part, that most Medically Needy patients would not be able to “remotely” afford monthly premiums that are part of the plan.

The Medically Needy program, which the agency says will cost about $1 billion this fiscal year, serves people who have often-debilitating conditions but don’t qualify for the regular Medicaid program because of their income levels. On average, more than 48,000 people are enrolled in the program each month, and it serves a combined total of 250,000 people a year, according to the document submitted to the federal government.

Some lawmakers have repeatedly argued in the past for scaling back the program — but the idea has met with fierce opposition from advocacy groups and hospitals, which provide much of the care to the patients. Among the most outspoken opponents during legislative debates have been organ-transplant recipients.

Lawmakers in 2011 approved a massive overhaul of the Medicaid system that included changes in the Medically Needy program. AHCA on April 26 sent a request to the federal Centers for Medicare & Medicaid Services for what is known as a “waiver” amendment that would carry out the changes.

The proposal would require Medically Needy beneficiaries to enroll in a statewide provider-service network, a type of managed care that would be responsible for trying to better coordinate services that patients receive. Eventually, the beneficiaries would transition into a broader statewide managed-care system that is the key part of the 2011 law.

The Medically Needy program uses a complicated process in which patients have to qualify each month based on the amount of medical bills they rack up and their income levels. Under the proposed changes, they would continue to qualify for the first month of coverage in that way and then would move into the provider-service network.

In the request to the federal government, AHCA touted that the proposal would allow Medically Needy patients to stay in the program for up to six months without having to qualify each month. It said, in part, that such a change would improve care and remove an incentive for Medically Needy patients to incur medical bills to meet monthly qualification requirements.

“Recipients (would) have access to care coordination, and the incentive is removed for the emergency room to be the first choice of setting for medical care in order to qualify for eligibility,” the document said.

But the proposal also includes a new premium requirement that Florida CHAIN contends would force Medically Needy beneficiaries to pick up a larger share of their medical costs than under the current system and could be unaffordable for many. The amount of premiums would vary, based on factors such as income levels and family sizes.

The proposal, however, includes a “grace period” that would allow people to stay in the program for 90 days before they would be forced out because of non-payment of premiums.

AHCA needs approval from the Centers for Medicare & Medicaid Services before it can move forward with the changes, as Medicaid is governed by federal law and is heavily funded by the federal government. Shelisha Coleman, an AHCA spokeswoman, said in an e-mail Tuesday that the federal agency is not required to respond to the request by a certain time.

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including,,, and Sunburn, the morning read of what’s hot in Florida politics. SaintPetersBlog has for three years running been ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.