Confusion reigns in Medicaid change

May 01--Starting today, Medicaid recipients accustomed to calling Marion Transit for a ride to doctor appointments will have to make other arrangements.

"The Agency for Health Care Administration has totally changed the system," said Sarah Stroh, executive director of Marion Senior Services, referring to Medicaid. "Statewide, it's a mess."

In 2005, the state began reforming Medicaid into a Statewide Medicaid Managed Care Program. There are two components: Long-Term Care was rolled out in Marion County in March; Managed Medical Assistance is being rolled out locally today.

Marion Senior Services operates the Marion Transit system, which provides low-cost rides to county residents who are "transportation disadvantaged." But under the new Medicaid program, the state no longer will pay Marion Transit to provide transportation services to doctor appointments for Medicaid recipients.

Instead, the state's Agency for Health Care Administration, which oversees Florida'sMedicaid program, has contracted with four insurance companies to provide those services in Region 3, which includes Marion County. Those companies are Prestige Health Choice, Staywell, Sunshine Health and UnitedHealthcare of Florida.

Those companies will offer health insurance plans for Medicaid recipients, and the plans will include transportation.

Stroh said Marion Transit discovered that many Medicaid recipients who were their clients were not aware their transportation was affected. As a result, people have had difficulty trying to make arrangements to get to doctor appointments.

"It's unorganized," said Wendy Andzeski, who arranges transportation for residents at Camelot Chateau, an assisted living facility in Ocala.

Camelot did not learn about the change until Sunday, when Marion Transit sent a fax stating it no longer could provide transportation to Medicaid recipients.

"They're senior citizens," Andzeski said about her clients. "They can't drive themselves from here to the doctor."

Andzeski said when a caseworker from UnitedHealthcare of Florida came to Camelot on Monday to check on clients, Andzeski asked her about transportation.

"She had no clue what I was talking about," Andzeski said.

Neither did a worker from Sunshine Health.

"I call it miscommunication," Andzeski said. "It's frustrating."

Shalisha Coleman, AHCA press secretary, said AHCA sent letters notifying each Medicaid recipient that he or she needed to choose a medical plan from one of the four insurance companies, called managed care organizations (MCOs). Transportation is provided under those medical plans.

"We contracted with the health plans. The health plans would contract with the transportation providers," Coleman said.

She said if the person failed to choose a medical plan, AHCA would assign one to him or her. In those cases, AHCA sent the Medicaid recipient a letter stating which company would be his or her MCO.

The problem is affecting doctors' offices, as well.

"We have had a few patients cancel their appointments because they do not have any transportation," said Merrit Sinclair, practice administrator at the Marion Oaks Medical Clinic. "It's affecting everybody significantly: the doctors, the nursing homes, the patients."

Sinclair said she called UnitedHealthcare to find out who would provide transportation and was told that Logisticare would be the contractor.

"They (Logisticare) don't have providers in Ocala right now, so I am not sure how patients are going to get to where they want to go," Sinclair said. "Nobody knows what these companies are using. The patient doesn't know. We don't know. It's a mess."

She was concerned, too, that some Medicaid recipients were placed in plans that were not affiliated with their doctors, so would not be able to see their doctors.

Justin Senior, AHCA's deputy secretary for Medicaid, estimated there would be about 3 million to 3.1 million Floridians in the statewide program.

Regions 2, 3 and 4 will be rolling out the Managed Medical Assistance program today. Marion County is in Region 3, along with Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Putnam, Sumter, Suwannee and Union counties.

There are 234,399 recipients in Region 3 who are eligible to participate in the program and 57,157, or 24.38 percent, have chosen a plan.

"We have had a really aggressive outreach campaign," Senior said.

AHCA has focused on informing provider organizations and recipients and has attended professional conferences, held webinars, and sent letters to recipients, he said.

"Anybody who wanted to know about it had numerous opportunities in a variety of different ways and venues to learn about the program," Senior said.

He said the agency mailed multiple items informing people about the changes and who to call and where to find information online. AHCA's website, which contains information about the new medical program, is http://www.ahca.myflorida.com/smmc.

Senior said people who have problems also can call a central Medicaid number: 1-877-724-2358.

He said if people are having problems, it is very important to bring the issue to their attention.

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Senior said one of the key elements of the plan is continuity of care. So, a Medicaid recipient can still use a former transportation or medical provider for the first 30 days, and the new company will pay those charges at the previous rate.

"It's extremely important that folks understand that," Senior said.

The four new companies should honor existing appointments and billing plans even if they are not under contract, Senior said.

"We will make sure they are paid," Senior said.

If people did not choose a company and AHCA put them in a plan they do not like, or that does not include their doctors, they can change the plan within the first 90 days. After that, they will be able to switch plans during an open enrollment period.

Both Stroh and Jennifer Mikula, administrator for Palm Gardens nursing home, said AHCA did a good job getting information out about the program.

"The state has done a great job," Mikula said.

But Mikula said when AHCA rolled out the Long Term Care portion in March, her organization had problems when it requested transportation for a client.

"They were clueless," Mikula said about the case workers.

"We are all waiting to find out who the transport companies are going to be," Mikula added.

She said her organization called Prestige on Tuesday to find out who the transport company is.

"They said they didn't know -- they will find out May 1st," Mikula said. "Our concern: We have dialysis patients that need to go to dialysis service on May 1. They really are holding back information. Maybe they didn't have it."

She said she is not confident things will work well today, but hopes it will.

"We are going to sit back tomorrow and hope for the best," she said Wednesday.

Stroh also was concerned about how 49 dialysis patients, who had been getting rides through her agency, would get to treatments.

"That's totally life and death," Stroh said. "We will continue to do that until they are able to transition and figure out how their transportation is going to work. That's absolutely the most critical population we have."

She said she has received "promises" her agency will be paid for those services.

"We are not sure how and when that will happen," Stroh said. "We made the decision to take on that 'risk' of hopefully getting payment in the future."

But it will not be taking any other Medicaid patients to medical appointments.

"We don't have contracts with the new providers," Stroh said about the four new companies.

She asked months ago about the transportation component and had been told the four companies would take care of transportation beginning May 1. She only learned Friday that she could get paid during the rollout. But no one could tell her how or when.

"We could quickly run up quite a big receivable not knowing when we would be paid," Stroh said.

She said that as a non-profit, she does not have cash flow to absorb that.

"It goes back to the whole misinformation thing," Stroh said. "Ultimately AHCA was responsible for this transition. I know there's all this confusion and finger pointing. In my opinion, it could have been avoided. This should have been ironed out the beginning of April, the latest."

Beth Nunnally, Sunshine Health's vice president for external relations, said her company will authorize payment to whoever provides transportation to Medicaid recipients for the first 60 days, regardless of whether they are in the plan.

Alia Faraj of Sunshine Health said TMS will be providing transportation under its plan. People can call TMS at 1-866-201-9968 or Sunshine's health care coordinators at 1-866-796-0530.

Crystal Warwell Walker of Staywell said her company is in its "quiet period" for financial reporting for public companies and, therefore, is unable to comment.

Doug Cook, executive vice president of Prestige Health Choice, could not be reached for comment.

Elizabeth Calzadilla-Fiolla of UnitedHealthcare said they do not expect any problems with transportation through this transition and that their provider is Logisticare.

"We don't anticipate any issues," she said.

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Contact Susan Latham Carr at 352-867-4156 or [email protected].

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