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State: Old Medicaid System For Kids 'No Longer Exists'

Florida Senate

Arguing that Medicaid has undergone a transformation, state officials pushed back Wednesday against a federal judge's finding that Florida has not properly provided health care to low-income children.

"Everything around the program has changed,'' state Medicaid director Justin Senior told the Senate Health and Human Services Appropriations Subcommittee. "He (the judge) is critiquing a situation on the ground that no longer exists, and that's unfortunate."

After nearly a decade of litigation, federal Judge Adalberto Jordan last week issued a 153-page decision that pointed to wide-ranging problems in how the Medicaid program has served children. In part, Jordan found that low physician reimbursement rates led to a lack of access to care and that children had been improperly dropped from the program.

It remains unclear what changes or actions Jordan might require the state to take. Jordan, who serves on the 11th U.S. Circuit Court of Appeals but heard much of the case while a district judge in Miami, indicated he will hold a hearing in late January to prepare for what he called the "remedy phase" of the case.

The state, however, will argue that the case is effectively moot because of a recently completed overhaul of the Medicaid system, which now enrolls almost all beneficiaries in managed-care plans. The lawsuit, filed in 2005, dealt primarily with issues in the Medicaid system from 2005 to 2009, Stuart Williams, general counsel for the state Agency for Health Care Administration, told the Senate panel Wednesday.

As an example of the changes, Senior said Medicaid managed-care plans are required to have adequate networks of doctors and other types of providers to serve children.

But Tallahassee physician Louis St. Petery, executive vice president of the Florida Chapter of the American Academy of Pediatrics, took issue with Senior's explanation about how managed care has resolved issues in the Medicaid system.

"From on the ground, those of us who are actually taking care of children on Medicaid, it really doesn't work exactly like that,'' said St. Petery, whose group has helped spearhead the lawsuit against the state.

For instance, St. Petery said children still lose eligibility improperly. Also, he questioned statements by Senior that the managed-care system will lead to fee increases for physicians. Low payments have long been a major issue in Medicaid, with many doctors saying it doesn't make financial sense to care for Medicaid patients.

St. Petery also told lawmakers that Agency for Health Care Administration officials have declined to talk with pediatricians about fixing problems in the Medicaid system.

"In every instance, we have been refused," St. Petery said. "They will not meet with us."

But Senate Health and Human Services Appropriations Chairman Rene Garcia, R-Hialeah, defended the agency's decision not to meet with pediatricians while the legal battle continues.

"I don't blame the agency for not wanting to meet or rejecting these meetings until that litigation has been resolved,'' Garcia said.

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