“New” Medically Needy Proposal Has Same Aim: Restrict Access for the Catastrophically Ill

PRESS RELEASE: October 18, 2012
Contact: Laura Goodhue, 954-213-8647, [email protected] 

Florida – The Agency for Health Care Administration (AHCA), Florida’s Medicaid agency, will hold a workshop tomorrow (October 19) in Ft. Lauderdale to collect public input on its third attempt at a proposal that, if approved, would end access to Medicaid coverage for countless vulnerable and medically indigent Floridians.  A second workshop is scheduled for October 23 in Tallahassee.

The Medically Needy (also called “Share of Cost”) program is the component of Medicaid that provides short-term coverage to patients who are over the income limit for regular Medicaid but have catastrophic medical expenses and are otherwise Medicaid-eligible.  Under the Medically Needy program today, once a patient’s total medical bills for the month – paid or unpaid – add up to an amount that approaches monthly family income, Medicaid coverage kicks in for the rest of that month. (That process is known as meeting Share of Cost for the month.) Among those who must rely on the program on an ongoing basis are dialysis patients, organ transplant recipients, and children with complex medical needs.

The Medically Needy proposal is just one part of a multi-prong request first submitted to federal officials last year seeking a broad waiver from Medicaid patient protections in order to: 1) require almost all Medicaid recipients statewide to enroll in for-profit HMOs and similar plans, and 2) give them more power over care-related decisions.

Advocates believe that the Medically Needy proposal is especially problematic: “The State has said throughout that their interest is ensuring continuous coverage for this vulnerable group, a commendable goal considering how many cycle on and off of Medically Needy during the year. But then they lower the boom: ‘Pay us up to 90 percent of your income in premiums and live on $200 a month from now on.’ That’s beyond cruel,” said Laura Goodhue, Executive Director of Florida CHAIN, a statewide network advocating with and for Medicaid patients.

Specifically, once a patient initially qualified for the Medically Needy program, (s)he would be enrolled in a managed care plan and required to pay to that plan monthly premiums in an amount up to their Share of Cost. AHCA’s current proposal does not provide precise estimates of what patients would have to pay, but an analysis of the previous version showed that the State expected recipients to pay as much as 90 percent of their income on these premiums. For example, a single individual with disability income of $1,200 per month would be expected to pay premiums of $1,000 every month.

“This is the how the State intends to quietly get out of the business of providing care for the catastrophically ill,” said Goodhue. (The Medically Needy program is already on the chopping block each legislative session.) “It doesn’t even sound like much of a change unless you understand what they’re really talking about,” she added.

The workshops themselves are only being held because of a brand new federal transparency law that requires states to allow for public awareness of and input on experiments like this Medically Needy proposal. The previous version of the proposal was quietly submitted one day before the new transparency law took effect, and was not made available to the public for weeks after that.

Florida CHAIN is a statewide advocacy organization dedicated to improving the health of all Floridians by promoting access to quality,affordable health care. CHAIN stands for Community Health Action Information Network. 

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