Herald Tribune
November 20, 2014
By Maggie Clark
Despite a threat that thousands of local needy residents could lose current access to the area’s only public hospital, Officials from the Florida Agency for Healthcare Administration (AHCA) say they won’t yet provide an opinion as to whether Staywell WellCare’s decision to drop Sarasota Memorial from its network would go against Florida’s Medicaid rules.
If the insurer and the hospital do not agree by the start of 2015, ACHA officials say, they’ll decide whether Medicaid recipients have “adequate” coverage without Sarasota Memorial as an in-network healthcare provider.
Staywell sent notices to the hospital, that Sarasota Memorial would not be a part of its network in the future. Staywell spokeswoman Crystal Walker said: “We are confident in our network adequacy without Sarasota Memorial Hospital and are well-equipped to serve members in the Sarasota area after Dec. 31, 2014.”
Concerns about network adequacy have plagued Medicaid managed care since the early 2000s, when privitization first took shape.
Joan Alker, executive director at the Center for Children and Families at Georgetown University, led a team of researchers in a multi-year study of Florida’s Medicaid program.“There were a lot of concerns among providers about what managed care would mean, and this is a very troubling development for Sarasota,” Alker said.“There are always power struggles between hospitals and managed care companies, but it’s pretty unusual that the largest plan moves to drop the largest hospital,” Alker said.
Hospital officials say if patients need immediate care and hospital admission, they will not be turned away.
Both Sarasota Memorial and Staywell say, too, they would like to maintain a relationship.
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