Misrepresentation and Secrecy: The Keys to Medicaid Privatization

A few weeks ago, Florida CHAIN exposed the fact that the Agency for Health Care Administration (AHCA), Florida’s Medicaid agency, had secretly submitted a request to federal officials insisting that Medically Needy patients somehow spend up to 90% of their income each month in order to retain access to Medicaid coverage. Particularly disconcerting was the fact that AHCA submitted its proposal one day before new federal transparency rules went into effect.

It might be unrealistic for patients and their advocates to expect to get information about exactly what State officials are doing to undercut Medicaid in real time, but it’s become common to find out what has been proposed only after the fact, if at all. When pushing to impose harmful changes on Medicaid patients without drawing too much attention, it turns out that suppressing and withholding information is a key tool in the State’s toolkit. Because it’s the poorest and most marginalized who are affected, however, the State has been able to get away with it.

Unfortunately, the State has several other tools at its disposal, and they too can inflict serious damage. Perhaps the most powerful among them has been the selective use and misrepresentation of information. We have seen this repeatedly with the State’s insistence that federal officials allow Florida Medicaid to be turned over to HMOs (and other managed care plans forced to act like HMOs).

The basis for the State’s demand is that the five-county Medicaid Reform experiment has been a resounding success, and so expanding this experimental version of managed care statewide is not only justifiable, it’s needed. AHCA representatives have taken to saying this so often that even some unsuspecting advocates have repeated their slogans.

The repeated boasts of success are really based on only three sources, however: 1) patient satisfaction data, 2) plan performance data, and 3) spending analyses. This week, Florida CHAIN and the Florida Center for Fiscal and Economic Policy sent a detailed letter to federal officials exposing (and in some cases re-exposes) the fatal flaws with these claims in detail.

To illustrate, we briefly consider the most often repeated claim, namely that patient satisfaction levels are high in the Reform Pilot. First, it’s important to note that the State had no choice but to steer the focus toward patient satisfaction, because they lack the data to directly counter the many accounts of denied and delayed access to necessary care. That’s because six years later, the promised patient “encounter data system” that was to answer that question still can’t do it,  and the Legislature is spending ¾ of a million dollars to assess whether the system currently in place might need to be overhauled. The one and only report AHCA has produced using encounter data that looks at access to care revealed almost nothing, and the little it did reveal wasn’t even what AHCA said it was. Not to mention that this is the same system over which 53 counties have sued the State in an effort to avoid paying the faulty bills that that system has kicked out.

That brings us back to patient satisfaction data, at least as a fallback. That might at least count for something, except that the survey results are based on a response rate that is about half of the minimum necessary. More importantly, the patients missed – or in some cases deliberately omitted – were far more likely to be those experiencing the greatest barriers to care.

The wagons are circled, however, and nowhere in any official document is there any admission of even a hint of concern that the State may not be adequately protecting some groups of patients from HMOs in the five counties, let alone that it may be unable to protect virtually all patient groups in all 67 counties.

Please watch for opportunities in the coming weeks to help remind decision-makers that there’s a real risk to patients and taxpayers behind the Medicaid privatization push propaganda.