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A Recent Phone Conservation With Retired Senator Bob Graham Submitted August 22, 2007
I wanted to share with you and the MS group the phone call that I had with Retired Senator Bob Graham, who is on the Board of Directors of Florida Medicaid StayWell (WellCare) Insurance, on Friday Aug 17, 2007. StayWell and HealthEZ insurance are the two big players in the Medicaid HMO groups.
Sen. Graham and I discussed my son’s experience concerning the healthcare Jason has received for the last 3 years. I also told him about the issues I have found that were important to look into concerning the new proposed Medicaid program introduced in 2005, which will go to the entire State of Florida in 2011. This proposed program was implemented in 5 counties in Florida so far, Broward and Duval Counties on July 1, 2006, and Baker, Clay and Nassau Counties in 2007. All of them have reported major issues with the red-tape and the lack of support for the specialist in the program.
This proposal handed over the Medicaid program to the participating HMO’s, and took it mostly out of the State of Florida hands, although there was a recent case implemented by the CMS section of the U.S. Health and Human Services Board, because of mal-treatment in regard to authorization delays, medication errors, and a lack of access to specialists and poor-quality medical care at company clinics that was reported in Vero Beach, FL, against America Health’s Choice HMO in July, 2007. So there is some oversight, albeit outside the States involvement.
We all need to realize that even though we or our families are not currently on Medicaid, that doesn’t mean that we never will be, and we need to keep vigilant on these issues. I am not against saving tax payer money, but I am against waste and making chronically ill patients unable to receive the care they need to live a quality life.
Some facts:
For those that wish to read up on this Proposed Medicaid plan here is a link:
A Medicaid physician and specialist are paid only 34 cents on the dollar that is paid by other insurances and out of pocket members.
Florida has the authority to limit spending on the benefits each program recipient receives. (This is my biggest concern.)
Georgetown University reports on the proposed Medicaid program, and Sen. Graham told me that there was a recent report from the GAO, General Accounting Office, that was not favorable to it.
Here is a link to the Georgetown University site report on the problems with the new proposed program from May 2007: http://ihcrp.georgetown.edu/floridamedicaid/pdfs/briefing2.pdf
Many newspaper reporters from the 3 initial areas have written articles concerning problems that the Medicaid recipients in the 5 counties have run into since it was introduced.
One of the things I proposed was getting the MS Society, the Cancer Society and other health related society’s more involved in the initial prognosis and the patient’s care regiment, and work with the State run Medical Departments, like USF and Shands, that specialize in areas of MS, Oncology, Parkinson’s, etc.. This would stop some of the flaws that specialist seem to have to make their own diagnosis and testing after another specialist in the field has given their diagnosis and backed it up with test results, which is what happen in my son’s case. Because of this my son almost died waiting until we got him to the University of South Florida MS Department and the experts there who put my son on MS regiment medicine that has kept him out of the hospital for 9 months now! This is after he was in the hospital and rehab centers over 2 dozen times before he was placed on this medication!
I also said I would like to see the HMO’s setting up a more efficient payment program to pay the physicians on time, as a lot of the physician’s that my son has visited have told us that they do not get paid for months from these HMO’s. This is after Ross Perot’s Texas EDS Corporation was awarded a $253 million contract to develop and manage a new system for Florida's Medicaid program in 2005. During my discussions with the CFO of StayWell insurance, I found out this million dollar contract was not to pay the Dr’s, but to pay the HMO’s and the Florida government for their expenses. The HMO’s are the ones causing the payment problems it seems from the lack of workers assigned to these tasks in the organizations. This is qualified as a major reason why more physicians do not sign up to accept Medicaid patients. As you can see I have been doing a lot of research on this, and will be doing a dissertation in my Doctorate program in 2010 on this vital healthcare issue. I hope by that time we have something that we all can be proud of not just in Florida but the entire United States. It is my goal to get more people interested in this so they will start asking their State and Federal legislators to get more involved in this proposed Section 1115 Medicaid Reform Waiver proposal before it becomes an even bigger problem. Thank you,
Karen Kuether |
