Disability, elder advocates fear impact of Medicaid changes

When Alyssa Holley turned 20 months old, she suddenly forgot everything.

Struck with a neurological disorder called Rett Syndrome, Alyssa transformed from a normal, healthy baby into one who lost virtually every skill she had developed.

Now age 18, Alyssa requires diapers, daily nursing and other forms of constant care -- which makes her mother, Gail Holley, nervous about the state's overhaul of Medicaid, the complex health care safety net on which her daughter relies.

The soft-spoken mother was among the last to testify in Tallahassee on Friday at the Agency for Health Care Administration's first public meeting to discuss major changes coming to the program.

"It's the families that are affected, and these individuals; don't forget about that," Gail Holley, a Leon County resident, said during the meeting. "We're not numbers. We're not dollars."

Gov. Rick Scott signed legislation on June 2 that will further privatize Florida's $20-billion Medicaid program by transferring its roughly 3 million poor and disabled beneficiaries to HMOs and other managed-care entities.

Doing so will slow Medicaid's rapidly escalating costs, lawmakers said this spring as they pared down the state budget to prevent a $4 billion deficit. A former healthcare executive, Scott urged lawmakers to approve the change.

Supporters also claim the changes can improve care by better coordinating it. But patient advocates and other critics fear that managed-care organizations' drive to turn a profit will wind up harming patients.

Summer Pfeiffer, of the Children's Home Society, warned that Medicaid has already tried a managed-care approach to handling the treatment of abused, disturbed foster children living in group homes. It didn't work, she said; the private plans did not provide the needed services. Ultimately, the state had to devise a different system of caring for those children.

The Children's Home Society tried in vain this spring to convince lawmakers to leave that population of children out of Medicaid managed care, she told reporters. "So we'll go back to what we experienced in 1997."

Seniors may suffer, attorney Twyla Sketchley testified, because the new law rewards managed care plans for keeping seniors out of nursing homes.

The program will emphasize home- and community-based forms of long-term care, which some advocates for seniors have applauded.

But Sketchley and other elder law attorneys said Friday there are not enough to safeguards to ensure that people who need nursing home care will get it, or that those who remain at home are properly tended.

Sketchley called it "granny dumping for profit."

Anne Swerlick, an attorney with Florida Legal Services, raised concern over the $10 monthly premium that the new law will force Medicaid patients to pay. "We have people who are living on cash assistance as low as $250 a month for a mother and a child. There is no way that they can pay $10 a month."

Most of those policies are not up to AHCA, which is charged now with carrying out the new law, said Roberta Bradford, deputy secretary for Medicaid. The public can still influence the agency's plan for implementation, she said, like ensuring that provider networks are adequate to cover the needs of patients.

Bradford encouraged the public to testify at future meetings about their experiences with Medicaid, managed care or both.

The pending overhaul builds on a five-year, five-county managed-care pilot project championed by former Gov. Jeb Bush. Analyses of the pilot's cost-effectiveness have varied widely since its start, as have reports about patients' access to doctors and treatment.

The state will need federal approval for the changes since the federal government provides the majority of the program's funding. AHCA's plan for implementing the changes is due Aug. 1.

AHCA will hold a public meeting in Largo from 9 a.m. to noon on Wednesdayat the Mary Grizzle Building, 11351 Ulmerton Road, and in Tampa on Thursday, 9 a.m. to noon, at the state Department of Transportation, 11201 N. McKinley Drive.