Florida’s most vulnerable elders are going to be dumped literally out in the cold so that managed care organizations can make a profit.
Hello. I’m Charlie Robinson an Elder Law Attorney in Clearwater, Florida. I am a Board member and past President of Area Agency on Aging of Pasco-Pinellas, Inc., Board Member of Florida Council On Aging , Vice-Chair of the Dept. of Elder Affairs Advisory Council, past Chair of the Florida Bar Elder Law Section and daily advocate for Florida’s senior citizens. The following is my testimony at the public hearing before the Agency for Health Care Administration June 15, 2011, on the Florida Medicaid reform legislation passed in 2011:
Florida is poised to place thousands of long term care patients at risk of literally being left out in the cold without services.
Florida’s current system is unsustainable. We have 60,000 plus on waiting lists for senior services. Our AAA averages over 2,000 people on waiting lists for Pasco and Pinellas alone. I strongly believe that the legislation passed as HB 7107 is going to make our problems worse, not better. The recession has added many to the Medicaid rolls and our current system will break at some point and that point is not far away. Any one of several challenges can break our system. Alzheimer’s disease without a cure can break the system. The runaway instance of autism in children can break our system. The baby boomers cannot expect the services that have been delivered under the current system with the age tsunami that is coming soon.
Our challenge is to design a new system that works. That is not what is happening in Florida. We are taking a system that has been deemed a failure by every neutral organization that has studied the six year Managed Care Demonstration project in Broward, Duval, and the rural counties around Duval. What do you do when it is clear that the experiment is a bust? You choose a different population, in this case elders, and you make it statewide. This is like the retailer logic that “We will lose money on every sale but make it up in volume.”
Based on budget concerns in difficult economic times, Florida has passed legislation that will provide bonuses to managed care organizations for dumping Florida’s seniors out of nursing homes. Remember years ago when family members were accused of granny dumping into nursing homes. Now we will see granny dumping out of the nursing home. These provisions incentivizing discharge from nursing homes will cause life-threatening harm to Florida’s most fragile and vulnerable citizens. It creates a profit incentive for managed care organizations to discharge long term care patients from skilled nursing facilities and can only be described as “Granny dumping for profit.” Even worse yet, granny may have to get on a brand new waiting list to access services that don’t meet her care needs in the community.
According to the May 27th 2011 edition of HealthNews Florida, Florida HMOs enjoyed $675 million dollars profit in 2010.
Florida’s Medicaid Reform legislation replaces the current level of care, which is determined by the verifiable criteria based on activities of daily living and level of cognitive impairment, with ambiguous need for care criteria that appear to be based on vague and indeterminate risk assessments. Managed care companies will be paid bonuses for evicting the elderly from nursing homes based on vague, arbitrary need for care determinations.
Protections and grievance procedures to prevent these evictions and other egregious violations by managed care plans, if they exist, are inadequate and insufficient to protect Florida’s most fragile and vulnerable citizens.
The irreparable harm that will be brought upon Florida’s most defenseless citizens by this scheme is made even more deplorable when other provisions in Medicaid Reform are taken into account. There is no validated data to track inappropriate denials of coverage or fraud in this system so Granny dumping for profit will go undetected by the minimal regulatory system. Further, the at risk citizens who will be evicted, can be dumped into unsafe environments with no services and no funding available for life-saving services because Florida’s Medicaid Reform states there is no right or guarantee for home and community based services despite the profit incentive to managed care organizations to put them there. These vulnerable elders can then be subjected to share of cost requirements for services that exceed their income, making necessary and life-saving care beyond their reach.
This scheme was passed on the hope of saving money for Florida’s tax payers. There is no evidence that Florida’s tax payers will save money with this scheme to dump Florida’s elders for profit. However, there is ample proof in Florida, including a recent expose that grabbed national attention, that there is little or no protection for Florida’s most helpless citizens whose last hope and only safety net is Florida’s Medicaid program and the life-saving services it funds.
The Nursing Home Diversion program experience is a terrifying model for the new managed care program. Diversion does not pay a penny for room and board. Some assisted living facilities accept granny’s retirement income as her room and board charge but they don’t have to do so. We have seen many situations that work exactly like this 1,2,3 example:
The ALF charges $3,000 per month, allocating their bill as $1,000 for care and $2,000 for room and board. Diversion provider pays approximately $1,000 per month to the ALF out of the capitated rate of $1,600. Granny’s assets are under $2,000 and her only source of income is her Social Security check of $1,000 per month. That leaves her $1,000 short of the ability to pay her share of cost to the ALF. If there is not a family member able to pick up $1,000 per month shortfall, granny is on the street. If she is married and her husband pays the $1,000 difference, he is being impoverished. It is rare in these economic times that the adult children, struggling financially in their own right, are able to make up the shortfall.
Given the imminent, irreparable danger to and the inadequate safeguards, funding and protections for dual eligibles, those persons qualified for both Medicare and Medicaid and Florida’s elderly who need long term care, combined with inadequate resources and lack of experience to address the special healthcare needs of these fragile and vulnerable citizens , they must be excluded from this experiment.
Instead, let us challenge our best, brightest, and most experienced Floridians to work together designing a new system that will start with more commitment to the aging services community to provide home-based services and get rid of the waiting lists. The inability to receive community based care results in more nursing home admissions.
We don’t need managed care gatekeepers to add to the expense burden. Florida should be the living laboratory to figure out how to handle the age wave to provide innovative solutions. This managed care fiasco is a big step backwards for a Florida that can’t afford to drive in reverse much longer.
