Altruis Blog

For safety-net providers, Florida proves particularly challenging. It just may get worse.

Jul 27, 2018 4:18:44 PM / by Chris Caspar, CEO

It’s tough to be sick and poor and in Florida. It’s almost as tough to be a FQHC or CHC that serves the sick and poor in Florida.

Each patient and provider probably has a story illustrating this, but let’s start with the obvious: Florida remains one of only 17 states that haven’t expanded Medicaid, and that’s not likely to change.

Medicaid expansion would likely cut Florida’s uninsured rate from 15.7 percent to nearly 11, according to data from the Urban Institute. Roughly 660,000 uninsured adults would be eligible for coverage.

Efforts to expand Medicaid have failed, but supporters hope the upcoming mid-term elections will turn the tide. Florida Democrats intend to make healthcare access a cornerstone of statewide election efforts, according to Florida Politics. And supporters say expansion is gaining public support. Just not enough--or soon enough.

Any hopes are likely to be dashed, at least during this election cycle, reports Kaiser Health News

“I don’t see Medicaid expansion having much of a chance,” Carol Weissert, Florida State University’s chair of civic education and political science, told Kaiser Health News. “It’s a combination of the political reality on the ground, and I don’t see a huge push for it around the state.”

From bad to worse?

Florida ranks 47th in overall Medicaid spending per enrollee (full or partial benefit) and 49th in Medicaid spending per each full-benefit enrollee, according to the most recent data from the Kaiser Family Foundation.

It soon may become even harder to collect what little money there is: Earlier this year, Florida submitted a Section 1115 Medicaid waiver request to eliminate retroactive coverage. 

Joan Alker, executive director of Georgetown University’s Health Policy Institute’s Center for Children & Families, argues that Florida’s proposal “… is a bad idea that will expose families to medical debt and providers to higher uncompensated care costs. There is absolutely no reasonable policy justification and there appears to be a blatant attempt to cut costs by delaying coverage and long-term care for people who need help now, not later.” 

Finally, on top of all that, we’ve learned that it may become even harder for the most vulnerable to obtain the coverage to which they are entitled: Navigators help enroll individuals in health coverage, including Medicaid and CHIP. But those programs have been slashed around the country. Those in Florida will have their funding cut by 81 percent this year, Florida Trend reports. 

Florida just is different

To those living in the other 49 states, some of this will sound familiar. But Florida’s situation is especially troubling. Consider: 

  • In the Best State ranking from S. News & World Report, the Sunshine State ranked 34th for healthcare, based on data from consulting giant McKinsey.
  • The Commonwealth Fund’s annual healthcare performance scorecard ranked Florida 48thamong all 50 states and the District of Columbia.

Everyone is affected, of course, but  it’s always the most vulnerable--and those who care for them--who suffer the most. 

Still, it’s not all bad: There have been some positive changes, especially around children:

  • Florida’s child uninsured rate has declined considerably over the last few years; it’s now 6.2 percent.(That’s still higher than the national rate of 4.5 percent.) 
  • Thanks to  recently enacted legislation, Florida won’t be able to reduce eligibility levelsfor children in the CHIP and Medicaid programs.
  • The proposed ban on retroactive Medicaid won’t affect children and pregnant women.

About those legal challenges…

Meanwhile, managed care organizations are challenging the Agency for Health Care Administration (AHCA) award of roughly $90 billion in Medicaid contracts to plans across the state. The 27 challenges, grouped into five cases, will be heard in administrative court in August. 

If the AHCA’s changes remain in place, it could shift tens of thousands of patients with HIV or serious mental illness into new Medicaid health plans, forcing many to switch doctors, the Jacksonville Business Journal reports.

As a result, some patients will have trouble figuring out which providers they can use, advocates told the Journal. Mike Kahane of the AIDS Healthcare Foundation warns that “people are going to fall out of care and have their care interrupted.”

Andrea Katz, CEO of Archways, a mental health provider, echoed the sentiment: “Many people with mental illness are very concrete in their thinking, and it’s a little bit more difficult for them to understand that it’s not personal that the doctor won’t see them and that it’s the insurance, not them.”

Keeping doors open

Amid all of this, FQHCs and CHC are just struggling to keep the doors open. We understand: Your mission comes first, but no revenue, no mission. At Altruis, our sole focus is helping you achieve your mission of providing care. 

If you’re going to be attending the FACHC Conference July 29-August 1, stop by Booth #210 and see us. We’ll share how we are helping Florida’s safety-net providers capture the revenue need in order continue to serve their communities. 

 

Topics: Revenue Cycle Management, Medicaid, Medical Billing Service, RetroPay, Billing Solutions, RHC, FQHC

Chris Caspar, CEO

Written by Chris Caspar, CEO