Medicaid cure to be headache

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A short-term Medicaid fix in the federal health care reform law will ease the financial burden on many of this area’s physicians.

But Florida’s poor and the doctors who treat them could be in store for a long-term headache.

Tucked away in the new federal legislation, which may add 1.7 million new enrollees to the state’s $19 billion Medicaid program by 2019, is a dramatic boost in reimbursements to primary care physicians.

One catch: The funding is available only in 2013 and 2014. After that, even as the Medicaid rolls expand, reimbursements could return to their present level in Florida — roughly half that of Medicare.

The problem is, many doctors in the state already shun Medicaid patients. Without higher reimbursements, more patients may end up competing for even fewer doctors.

And, as the funding goes away, the insurance mandate and expanded Medicaid eligibility takes effect.

“You’ll have a Medicaid card, but it doesn’t really ensure you that you’ll get health care,” said Dr. Louis St. Petery, executive vice president of the Florida Pediatric Society. “And that’s not appropriate for children or adults.”

The society and others are suing Florida in federal court over Medicaid rates that are lower than most other states and, they claim, result in less care for the state’s children.

Supporters of health care reform concede that the two-year Medicaid rate bump may do little to improve access to physicians.

Dr. Frederick Turton, a Sarasota physician and chairman of the American College of Physicians’ Board of Regents, said fixing the details of health reform will likely continue for some time.

“Health care reform is a journey, not a destination,” said Turton, whose organization supported the new law. “We didn’t reach the destination when President Obama signed this legislation. There’s a lot more work to do.”

The higher reimbursements in 2013 and 2014 will not apply to many other medical providers, such as dentists and specialists.

And cash-strapped states such as Florida may not relish making up the reimbursement difference when the rates lose federal funding in 2015.

“It is essential that we pay primary care doctors fairly so they’ll care for new patients covered under Medicaid,” said Lori Parham, state director of AARP Florida in an e-mail. “We’ll continue to work with leaders at the federal and state level to make certain payment rates are sufficient going forward.”

Access to care remains a problem for the state’s 2.7 million Medicaid patients.

A 2008 study by the Center for Studying Health System Change found that 40 percent of physicians nationwide accept new patients on the insurance plan.

The Medicaid conundrum is front and center at the state Legislature, which is debating a dramatic re-shaping of the entitlement, including privatization of the program.

As this happens, local providers can only guess what the health care landscape will look like in a few years.

State officials estimate that as many as 1.7 million residents could turn to Medicaid in the next decade and eventually cost Florida an extra $1 billion or so per year.

Much of the Medicaid burden could fall to the state’s public hospitals, which are obligated to treat them.

The recession has already started making that a reality. Medicaid enrollment jumped 25 percent last year in Lee County.

Lee Memorial Health System has recently begun talks with Family Health Centers of Southwest Florida to figure out the looming Medicaid increase here, said system President Jim Nathan.

Family Health Centers is one of this county’s primary health care providers for Medicaid patients.

It holds a special regulatory status that grants it higher Medicaid reimbursement rates than the system and other area physicians.

Growth in Medicaid poses unique challenges for each organization.

Lee Memorial loses money with each Medicaid patient it treats, officials say. Reimbursement rates cover roughly 30 percent of treatment charges in the system.

Family Health Centers may have challenges recruiting enough doctors to cover an influx of new Medicaid patients.

“I hope we can find a shared vision over the next six, eight months with them,” Nathan said.

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news-press.com

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