Herald-Tribune

By: Barbara Peters-Smith

During the Medicaid forum on kids’ lack of healthcare, the panelists emphasized that Medicaid has to start being recognized, not as a government deal for the low-income people, but as an essential health care for at least half of the children in Florida.

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“I think the children’s piece tends to get overlooked,” said Joan Alker, a researcher for Georgetown University’s Health Policy Institute, even though 42 percent of Florida’s children rely on Medicaid for all their medical needs. “If you looked at kids 0 to 5, it would probably be closer to 50 percent. You’re not going to see another system that is touching so many kids’ lives.”

The Herald-Tribune presented the free community forum, “Medicaid in Florida: How Is Florida’s Managed Care Working for Children?” in response to a January investigative project by reporter Maggie Clark. Since the report ran, the state’s Agency for Health Care Administration has settled a major lawsuit by promising to consult with pediatricians and raise the quality level of care. But Alker sees little hope for dramatic improvement arising from the legal agreement: “I have to say the targets are not that ambitious.”

At the Herald-Tribune’s suggestion, Alker’s institute at Georgetown embarked on a survey of Florida’s pediatricians to determine just how hobbled they feel by the managed care companies. The study was paid for by the Community Foundation of Sarasota County. Responses from 131 doctors, detailed in a Sunday article by Clark, pointed to high dissatisfaction about their ability to refer children to specialists, and even higher concerns about “churning” — insurance plans dropping patients or switching their doctors without informing families.

The idea behind paying insurance companies to handle Medicaid cases, Alker said, is that “it’s a good thing to manage care and make sure patients are not subject to a myriad of procedures. And here the physicians are saying that it’s made care coordination more difficult. The majority thought that managed care had made the system worse for their patients.”

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She told of having newborns arrive at her office who had not been enrolled in a for-profit Medicaid plan, and difficulties getting her prescriptions processed while children were in pain. But her biggest complaint, in agreement with 59 percent of doctors in the Georgetown survey, was the problem finding specialists to take her patients.

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Alker said pressuring Florida lawmakers to fund Medicaid more generously, as other states have done, involves “educating folks that Medicaid is a kids’ program. You do not hear that, and your Legislature doesn’t talk about it like that.”

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