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It's Time To Fix This Medicaid Emergency

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By STEVEN R. WEST

Special to the Tribune

Published: March 22, 2009

The federal stimulus package includes important provisions related to the administration of Florida's Medicaid program. The stimulus bill provides a temporary increase in the federal match of Medicaid costs, which means Florida will pay a lower share for Medicaid services.

Through this provision, Florida is estimated to receive about $5 billion over the next three years. In order to qualify for these funds, the Florida Legislature must reverse plans to cut or restrict the Medicaid medically needy and Medicaid aged and disabled programs, which provide medical assistance to those with catastrophic illnesses so they don't fall into poverty. It is expected that the federal match increase will offset the costs of continuing these programs.

The health of our residents is central to economic prosperity, and this depends greatly on having a health care work force that is able to meet the diverse and growing needs of the state. Stimulus funds issued to Florida should be utilized toward increasing Medicaid reimbursement rates or, at the least, preventing rate cuts to those physicians and hospitals that provide critical services to those who are most in need.

At current Medicaid reimbursement levels, Florida already faces a crisis of access to care for the underserved. Today, only 31 percent of doctors in Florida are willing to take an emergency call, and this number is in steady decline. Florida was recently ranked 50th among the states for "access to emergency care" and was one of only 12 states to receive an "F" rating. Florida ranks 45th among states for emergency department wait times, with an average wait of four hours for a patient to receive care. The reasons behind this work force shortage are simple: Emergency "on call" physicians receive extremely low reimbursement, if any, for the services they provide to Medicaid enrollees or the uninsured. Further, these physicians face heightened liability for treatments they provide in these high-risk settings.

The long emergency room wait times can be alleviated by increasing Medicaid reimbursement for primary care physicians. This will improve access for patients and ultimately save the taxpayers more money by directing the care of Medicaid patients to physicians' offices rather than to costly emergency rooms.

This session, the Florida Legislature has an opportunity to take a strong stand for improving Florida's health care safety net by increasing physician "on-call" and primary care reimbursement rates. Without such efforts, the impact of economic stimulus dollars will be severely diminished.

Physician Steven R. West is president of the Florida Medical Association.

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