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Steve Jackson
How Florida Can Avoid Medicaid Litigation

The Florida Agency for Health Care Administration (AHCA), which oversees Florida’s Medicaid program, has signaled that it is working to develop a managed care plan that continues providing access to quality care for millions of Floridians.

Florida’s proposed Medicaid plan is not without its controversies, however, AHCA officials seem to be making a concerted effort to listen to the needs of patients and to work with health care providers toward structuring the program so that health care services will be adequately available. This attention to detail is especially important for populations with specific needs, such as the elderly or those dealing with cancer.

Where some states have decided to proceed with a one size fits all approach to their Medicaid programs, AHCA officials must understand the importance of workingwith patients and providers to develop a Medicaid plan that will work for everyone. Our state must ensure that its final plan surpasses Federal standards for access to care for patients. 

By law, all states must structure their programs so that the availability of care for Medicaid patients is equal to the availability of care for patients with private insurance. When states do not demonstrate the ability to meet this Federal standard with their Medicaid programs, all kinds of trouble ensues. 

A prime example of a state that has run into major problems with its Medicaid proposals is California.  The United States Supreme Court is now considering whether individuals can file a lawsuit against state governments that do not provide adequate Medicaid reimbursements to health care providers, because of California’s actions.

This Supreme Court case came about as a result of California’s attempt to cut provider reimbursements 10% in 2008, to a level at which health care providers could no longer afford to serve patients.  With so many providers, including pharmacies, hospitals and medical doctors concerned about the ability to participate in California Medicaid program (Medi-Cal), the ability of the program to meet Federal access standards was called into question, ultimately leading to the Supreme Court case taking place today.

The principle is simple.  When a sufficient number of qualified providers cannot afford to participate in Medicaid, patients loseaccess to care and states end up being in violation of Federal law.  California could have looked further down the road at the potential problems facing Medi-Cal, but instead, ended up with a Supreme Court battle on its hands.  This is a potential area where Florida could attract Federal scrutiny unless AHCA canclearly demonstrate that patient access to care will be sufficient for the state’s growing number of Medicaid recipients.  It is not too late, however, for Florida to design a Medicaid program that the Centers for Medicare and Medicaid Services (CMS) will sign off on.

Sufficient Medicaid access begins with designing a program that allows for all qualified providers, who play by the rules, to participate in the program.  In the case of pharmacy care and services, excluding certain providers could leave those in underserved areas with no way of accessing the care they need.  Floridians value the relationships they have with their pharmacists; relationships that are invaluable to countless individuals and families.  If our lawmakers continue listening to patients and providers, we can be confident that Florida Medicaid will remain strong.

Steve Jackson, Owner of Jackson-Pace Pharmacy in Pensacola.

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by Dr. Radut.