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Florida Medicaid cuts target food for disabled children
In a despicable and callous act, Florida Medicaid officials have begun denying funding for special liquid food formulas used by some children suffering from HIV/AIDS, undergoing dialysis, or living with severe physical disabilities, according to reports published in the Miami Herald. Thousands of children are endangered by the unannounced policy change. Doctors and dietitians have condemned the cuts.
Most at risk are children disabled with birth defects and degenerative diseases who require liquid sustenance via feeding tubes attached directly to their stomachs. Children with cerebral palsy and severe neurological impairments cannot swallow and therefore depend upon special prescription formula.
These cuts are part of a broader attempt by the state to sharply curtail Medicaid spending, including plans currently underway to privatize Medicaid services. Florida is viewed as a model for those seeking to dismantle the Medicaid entitlement program for the poor and elderly throughout the United States.
The Miami Herald reported March 12 that officials at the state Agency for Health Care Administration (AHCA) have denied that the changes were motivated by cost cutting; however, an e-mail obtained by the paper last week from an AHCA director stated the contrary. “We’ve made many policies more restrictive than in the past, due to the out-of-control costs of Medicaid,” the Medicaid program director Emily Fritz explained to a dietitian who had inquired about the cuts. “It was a tough, but necessary, decision,” she wrote.
AHCA Secretary Alan Levine, when asked by the Herald March 10, insisted that he had not heard of the changes, but offered bland assurances that he would be reviewing the new policies to ensure that no harm came to children. On the day the story ran, Levine issued a statement to Florida legislators declaring that the paper was engaging in sensationalism and that the article was “absolutely not true.”
“To be clear,” he wrote, “with the exception of experimental procedures, any service determined to be medically necessary for children is approved.” He suggested that the doctors themselves were to blame for denial of their patients’ requests. “Based on the information I have already been provided with, it appears the problems reported in the story are related to whether the physicians were adequately educated on how to access the prior authorization system.” Doctors interviewed by the Herald in a story published March 14 vigorously rejected these accusations.
In fact, the state appears to have been quietly restricting its definition of what it deems “medically necessary” when reimbursing doctors for services provided to Medicaid patients. As the e-mail from Fritz made clear, many similarly “tough” cuts and restrictions have recently been made under the radar. In implementing them, ACHA administrators have taken the decision of what is medically necessary out of the hands of medical practitioners, who are increasingly being told that they will be reimbursed for only the most minimal services.
More
http://wsws.org/articles/2006/mar2006/medi-m17.shtml
These cuts are part of a broader attempt by the state to sharply curtail Medicaid spending, including plans currently underway to privatize Medicaid services. Florida is viewed as a model for those seeking to dismantle the Medicaid entitlement program for the poor and elderly throughout the United States.
The Miami Herald reported March 12 that officials at the state Agency for Health Care Administration (AHCA) have denied that the changes were motivated by cost cutting; however, an e-mail obtained by the paper last week from an AHCA director stated the contrary. “We’ve made many policies more restrictive than in the past, due to the out-of-control costs of Medicaid,” the Medicaid program director Emily Fritz explained to a dietitian who had inquired about the cuts. “It was a tough, but necessary, decision,” she wrote.
AHCA Secretary Alan Levine, when asked by the Herald March 10, insisted that he had not heard of the changes, but offered bland assurances that he would be reviewing the new policies to ensure that no harm came to children. On the day the story ran, Levine issued a statement to Florida legislators declaring that the paper was engaging in sensationalism and that the article was “absolutely not true.”
“To be clear,” he wrote, “with the exception of experimental procedures, any service determined to be medically necessary for children is approved.” He suggested that the doctors themselves were to blame for denial of their patients’ requests. “Based on the information I have already been provided with, it appears the problems reported in the story are related to whether the physicians were adequately educated on how to access the prior authorization system.” Doctors interviewed by the Herald in a story published March 14 vigorously rejected these accusations.
In fact, the state appears to have been quietly restricting its definition of what it deems “medically necessary” when reimbursing doctors for services provided to Medicaid patients. As the e-mail from Fritz made clear, many similarly “tough” cuts and restrictions have recently been made under the radar. In implementing them, ACHA administrators have taken the decision of what is medically necessary out of the hands of medical practitioners, who are increasingly being told that they will be reimbursed for only the most minimal services.
More
http://wsws.org/articles/2006/mar2006/medi-m17.shtml
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You wrote:
"In fact, the state appears to have been quietly restricting its definition of what it deems “medically necessary” when reimbursing doctors for services provided to Medicaid patients. As the e-mail from Fritz made clear, many similarly “tough” cuts and restrictions have recently been made under the radar. In implementing them, ACHA administrators have taken the decision of what is medically necessary out of the hands of medical practitioners, who are increasingly being told that they will be reimbursed for only the most minimal services. "
I am a supplier providing very complex and high-tech wheelchair seating systems for the disabled population in Florida. I know your statements to be true. We also utilize the PRIOR AUTHORIZATION procedure for the proivision of this equipment, very similar to what is described above.
We have found that, in the past year or so, the process has become extremely restrictive, cumbersome and obstinate. It is important to note that almost every case has ultimately gotten a favorable decision, but the delays that result have been atrocious and truly harmful to the patients. It appears Medicaid prior authorization personnel are using a delay tactic in an attempt to lower their rates of spending.
My company has been providing similar services for over 20 years in Florida, and Medicaid Prior Auth packets are prepared with great attention to detail, using recommended forms in conjunction with clinicians that are acknowledged as being among the best minds in the industry.
The actual expenditures in this category (customized or specialty wheelchairs and seating) are less than 1/10th of one percent of overall Florida Medicaid spending. Additionally, this equipment is widely known to prevent far more expensive medical procedures, and provides the only means for many children and adults to assume any semblance of normal life experience, as without it they would be confined to bed.
Sadly, it is easy to conclude that this population does not possess much voting power, so they are easy to single out for these types of "non-cuts".
When challenged, Medicaid is quick to point out that the goal for them, is reduction of fraud and abuse. The truth is, we provide a service that is mandated by federal guidelines, save Medicaid much larger expenditures in the long run, and are simply trying to earn an honest living by helping the less fortunate.
What a shame!
"In fact, the state appears to have been quietly restricting its definition of what it deems “medically necessary” when reimbursing doctors for services provided to Medicaid patients. As the e-mail from Fritz made clear, many similarly “tough” cuts and restrictions have recently been made under the radar. In implementing them, ACHA administrators have taken the decision of what is medically necessary out of the hands of medical practitioners, who are increasingly being told that they will be reimbursed for only the most minimal services. "
I am a supplier providing very complex and high-tech wheelchair seating systems for the disabled population in Florida. I know your statements to be true. We also utilize the PRIOR AUTHORIZATION procedure for the proivision of this equipment, very similar to what is described above.
We have found that, in the past year or so, the process has become extremely restrictive, cumbersome and obstinate. It is important to note that almost every case has ultimately gotten a favorable decision, but the delays that result have been atrocious and truly harmful to the patients. It appears Medicaid prior authorization personnel are using a delay tactic in an attempt to lower their rates of spending.
My company has been providing similar services for over 20 years in Florida, and Medicaid Prior Auth packets are prepared with great attention to detail, using recommended forms in conjunction with clinicians that are acknowledged as being among the best minds in the industry.
The actual expenditures in this category (customized or specialty wheelchairs and seating) are less than 1/10th of one percent of overall Florida Medicaid spending. Additionally, this equipment is widely known to prevent far more expensive medical procedures, and provides the only means for many children and adults to assume any semblance of normal life experience, as without it they would be confined to bed.
Sadly, it is easy to conclude that this population does not possess much voting power, so they are easy to single out for these types of "non-cuts".
When challenged, Medicaid is quick to point out that the goal for them, is reduction of fraud and abuse. The truth is, we provide a service that is mandated by federal guidelines, save Medicaid much larger expenditures in the long run, and are simply trying to earn an honest living by helping the less fortunate.
What a shame!
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