In a doubtful and discouraging move, it was reported that on Friday the US Department of Health and Human Services (HHS) approved the State of Florida request to expand its Medicaid privatization, at least for its long term care patients. With the elderly consuming as much as 70% of the costs of Medicaid, this ruling focuses on a large section of the costs, but it also puts the most vulnerable cases in the hands of private insurers whose primary motivation is profits, not care.
Many of those who will be affected are known as “dual eligible,” covered under Medicare, but due to poverty and/or the circumstances of care are also thrust into Medicaid. As those who have cared for the elderly know, Medicare will not cover maintenance type care that is provided by nursing homes. With costs upwards from $5000 per month for nursing home care, few can afford it and Medicaid is sought to cover those expenses. Further, seniors are on reduced incomes and are prone to require assistance with medical expenses beyond what Medicare covers.
Florida has sought this approval for two years as an avenue to alleviate its rising Medicaid costs. For the current Medicaid program, expenses are roughly split between federal and state funding. The expanded Medicaid program which Florida has (so far) resisted that is part of the Affordable Care Act – Obamacare – federal funding provides at least 90% of the costs until 2020. Still, Florida is among the stingiest Medicaid states:
As a low-tax state, Florida has long tried to run Medicaid on the cheap. It now ranks fourth from the bottom (ahead of California, Georgia, and Alabama) among states in the amount spent annually per enrollee, a number that has declined steadily over the years.
The Florida experiment with Medicaid privatization has been fraught with problems in its limited 5 county service area. Private insurers were bailing out of the program because it wasn’t profitable for them, and patients were then left hanging:
Nearly half of the 200,000 patients enrolled in the pilot have been dropped from at least one plan, federal health officials previously said.
Patients would often complain about the lack of available medical services offered by the private insurers. The quality of care was also haphazard. Like the experience of many with private insurers, there seems to be greater interest in denying care than providing it. For a good examination of the program, well linked and referenced, click here. The topic has been covered on this page before as well, here and here and here.
The pilot program was touted as demonstrating how privatization would provide less costly and more effective services. Neither has been shown to be true.
HHS is allowing this expansion to occur statewide, but it is difficult to understand their reasoning. Did Gov. Scott manage to pull a quid pro quo from HHS Secretary Kathleen Sibelius that will have Florida as a more cooperative participant in the ACA Medicaid expansion in exchange for this scandalous profit-from-the-poor scheme? If so, it was a really bad move since the prospect of billions in new federal revenue had unleashed the lobbying attention of the health care community, changing the ideologically idiotic minds in the Florida legislature as money tends to do.