Medicaid Changes Disasterous
In the last legislative session, Florida’s legislature passed sweeping changes to convert its current Medicaid system to a Managed Care model. On August 1, Florida’s Agency for Healthcare Administration submitted its proposal to the Center for Medicare and Medicaid Services (CMS). Many Federal regulations control how the Medicaid system works. Florida is requesting a waiver from the Federal rules in order to implement its proposed system. Florida’s elderly population and those who are concerned about the elderly population should be aware that Florida’s proposal will have a devastating effect on the senior population.
The overhaul passed has the laudable intention of moving seniors out of the most restrictive setting, nursing homes, and providing care to them in less restrictive settings such as assisted living facilities or in their homes. If this intention were executed in such a way to ensure care for those who need it, it would be a win for the elders and the taxpayers alike. Nursing home care is more expensive than assisted living, so if some of the current nursing home patients on Medicaid could be cared for in an assisted living setting, it would cost less and be less restrictive for the senior citizen.
The problem with the proposal as submitted to CMS is that it provides financial incentives for the Managed Care Organization to require individuals in nursing homes to make mandatory moves to assisted living facilities without any kind of mechanism to ensure that care will be available at the assisted living facility. The proposal provides that the care outside the nursing home will be subject to waiting lists and availability of funds. Were such individuals moved out of a nursing home subject to waiting list and availability of funds, they would have nowhere to live and no means of providing for their care.
The current Long Term Care Diversion Waiver program in Florida has long been plagued by waiting lists and unavailability of funds. Many people are eligible both from a health perspective as well as a financial perspective, but are unable to receive help under this program because of a lack of funding. Also, the Long Term Care Diversion program does not pay for room and board at an assisted living facility. Many people cannot afford the share of cost component to the diversion program. So the proposal that the Agency for Health Care administration has sent to CMS would allow a Managed Care Organization to discharge a vulnerable adult from a nursing home but not provide funding for an assisted living facility or home care for months or years. It also would not provide a way for the total cost of care to be provided for those individuals who cannot meet the share of cost component.
Collier County is part of Region 8 which includes a five county area. Under the proposal, the Managed Care Companies would service all of the region. Therefore, it is likely that if a Collier County resident were in a nursing home and determined by the managed care company to be able to be serviced by an assisted living facility, that the Managed Care Company may move that individual to a facility in one of the other five counties, perhaps as far away as Charlotte or Hendry Counties.
While it is possible to fix the system and provide a more cost effective way of serving the senior population, the Florida proposal is not the appropriate fix. CMS and our legislators need to hear from us that this is an unacceptable proposal. Contact CMS at:
Donald M. Berwick, M.D., M.P.P.
Administrator
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
Donald.Berwick@cms.hhs.gov
More than ever, Seniors need advocates who are speaking out for their needs and helping them and their families plan for their care.
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