Medicaid privatization deadline nears for recipients
By Pallavi Agarwal, Highlands Today, Sebring, Fla. | |
McClatchy-Tribune Information Services |
The change comes three years after <org>the Legislature voted to privatize the program, saying the roughly
The transition to the Statewide Medicaid Managed Care program is broken up into two components.
The long-term care population, which includes those 65 and over who reside in nursing homes, recently completed enrollment.
Enrollment in Managed Medical Assistance or the second part of the phase is underway in
As of
Those who don't enroll in a plan by the deadline don't lose coverage. The state will chose a plan for them but experts warn they may not be the right one for their health needs.
Coleman said they don't have the long-term care enrollment by county readily available as of yet, but as of
Its administrator
"We needed to educate our patients and their families"on plan choices, she said. Compared to some other regions, she felt
One big change under the managed care system is that their
"The personal case manager will be able to decide what's more appropriate for them (the recipients)," she said.
In
"We let them know which ones we accept, and if they are on a plan that we do not accept, we let them know that on their insurance card it has the Primary Care Provider's (PCP) name and office number that they have been assigned to," Gountas said.
The health department has also encountered some confusion over how to change providers or plans.
If clients want to receive services at the
Kurtz said it is important that
Gountas advised recipients to review all the mail they receive from
They also need to have a better understanding of the services that their new plan covers, he said. Services that where covered in the past may not be covered under their new plan, he added.
More than three million
Health advocates have worried about lapses in care during the transition, especially because the program is built on a controversial five-county pilot where many insurance companies dropped out and patients struggled to access doctors and treatments.
Under the new agreements, insurance companies are required to honor appointments or treatments that were already scheduled under another insurance company even if the provider is out of network. The lists of provider networks are also closely monitored -- a huge problem with the federal health law -- and uncompliant insurers can face financial penalties or potentially lose their contract.
Other states have privatized their
"On paper, I think this is one of the stronger agreements that we've seen with the federal government and I think that reflected the very high level of concern with
The statewide privatization, a victory for state Republicans, meant
Under
The state says insurance companies were required to have a larger network of doctors, hospitals and providers compared to the number of consumers.
Critics worry the state is abdicating care of its most vulnerable residents to for-profit companies with little oversight of how the money is being spent and say there's little evidence the pilot program improved patient care or saved money.
Insurance companies say they have an incentive to control costs by linking patients up with primary care doctors early on instead of treating them in more expensive setting like emergency rooms.
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