Thursday, January 08, 2015

A Sick System

Attached an editorial from today's Miami Herald titled " A Sick Situation" highlighting how broken our Medicaid system really is. Profits before Patients, that's the new mantra. Big insurance companies receive approximately $248 per member per month and physicians, who carry the burden of the care for the very sick and needy, get paid a pittance. Anyone wonders why physicians are dropping their Medicaid provider status? Why do we have to accept this nightmare of a so-called healthcare system for the poor? Yours Bernd A Sick System: Florida’s impoverished children need legislative champions on both sides of the aisle — again. Last week, a federal judge blasted the state of Florida for shortchanging poor and disabled children and the pediatricians who care for them by setting the state’s Medicaid budget at an abysmally and artificially low level for at least 10 years. As a result of the state’s dereliction, many pediatricians across the state dropped out of the program, meaning thousands of children are denied lower-cost preventive medical and dental care. That means that, too often, they have to get more-expensive emergency care when a preventable illness worsened. And that means that, in addition to state leaders turning their backs on sick children, they have shortchanged taxpaying Floridians, too. U.S. Judge Adalberto Jordan last week found that the state’s stinginess forced Medicaid providers for poor children to be paid far below what private insurers would pay. In addition, it was below what doctors in the Medicare program, which serves the elderly, were paid. And, he said, it was illegal, a violation of federal laws Stuart Singer, the Fort Lauderdale attorney who for a decade has been battling on behalf children receiving care through Medicaid, told the Editorial Board that Judge Jordan will set a hearing to start the process of determining “injunctive relief.” The lawsuit goes back a decade, spanning the administrations of Govs. Jeb Bush, Charlie Crist and, now, Rick Scott. This record of failure should end on the newly re-elected governor’s watch. The less the state spends on Medicaid for children’s care, the fewer matching funds it gets from the federal government. That makes no economic sense whatsoever. The state has argued that the violations cited are a thing of the past, and that it is providing cost-effective care through the Statewide Medicaid Managed Care program. The judge’s findings, however, tell a different story. According to Herald investigative reporter Carol Marbin Miller’s article, Judge Jordan found that: ▪ Almost 80 percent of children enrolled in the Medicaid program “are getting no dental services at all.” ▪ Because physicians’ payments are so low, one-third of the state’s children on Medicaid are without preventive medical care, whether they are paying fee-for-service or under managed care. ▪ A high percentage of infants have not had “a single well-child visit in the first 18 months of their lives.” ▪ Florida health regulators sometimes switched needy children from one Medicaid provider to another “without their parents’ knowledge or consent.” ▪ Thousands of children are kicked out of the Medicaid program each year, sometimes because of nothing more than bureaucratic error. Judge Jordan would do well to render a judgment that the state must end these practices and make Medicaid the reimbursement rate commensurate to that for Medicare. Last year, Sens. Eleanor Sobel, D-Hollywood, and Denise Grimsley, R-Sebring, teamed up to muscle through improvements in how the Department of Children & Families monitors abused and neglected kids in its care. Sick kids will need similar advocates in the upcoming legislative session. With a hefty budget surplus, the estimated $200 million needed surely can be found. There is no excuse for undercutting children’s health. Pay now, or pay later. Read more here: