Florida Health Justice Project issues Advocate's Guide to the Florida Long-Term Care Medicaid Waiver
Miriam Harmatz, J.D., Co-Director
Florida Health Justice Project
Office: (786) 558-4950
Cell: (786) 853-9385
(MIAMI) – Government-subsidized health-care benefits are critical for low-income Florida seniors – particularly those who are frail and disabled – but they can be hard to come by, which is why attorneys at the nonprofit Florida Health Justice Project (FHJP)and Legal Services of Greater Miami Inc. have published a guide for those advocates engaged in helping seniors access long-term care and related services under Florida Medicaid.
The Advocate's Guide to the Florida Long Term Care Medicaid Waiver, made available online thanks to the Florida Justice Technology Center (FJTC), concerns long-term services and supports that are essential to remaining at home or in the community rather than in a nursing home.
“For Florida seniors who want to stay out of a nursing home after they can no longer handle the routines of daily living, these services are critical, but like many Medicaid services, navigating the system is complicated,” said Miriam Harmatz, co-director of the Florida Health Justice Project, a new nonprofit advocacy organization. Earlier this year, the project prepared The Advocate’s Guide to the Florida Medicaid Program.
“These guides exemplify our mission and work,” Harmatz said. “Through collaboration with local legal services programs, FJTC and national partners, including Justice in Aging, we’re providing valuable resources for Florida’s legal aid and pro bono advocates who are helping clients get medically necessary services.” This is the second such collaboration between FHJP and FJTC.
As with The Advocate’s Guide to the Florida Medicaid Program, FJTC took the lead on dissemination by turning both guides into online, interactive versions.
“The advocate community plays such an important role in expanding access to justice, because they’re typically the ones advising and assisting those in need,” FJTC Project Manager Joseph Schieffer said. “We wanted to create something that would amplify their work and streamline the process to find information. Having the guide online makes it easier for advocates to navigate the content and share it with others.”
Long-term care – including both nursing home and community-based care – are both part of Florida Medicaid’s Long-Term Care Program. The new guide, however, focuses exclusively on the part of the program for those living at home or in the community, which falls under Florida Medicaid’s long-term care “waiver.” Under federal law, waivers allow states to provide home and community support services to a set number of people as an alternative to institutional care.
Also known as “home and community-based services,” the covered services are not typically available through Medicare or standard medical insurance, such as personal-care aides and private-duty nursing.
Nationwide, over half of people turning 65 will at some point develop a severe disability or medical condition that will require home and community-based services. Over 100,000 Floridians currently receive services through Florida Medicaid’s long-term care waiver, with over 50,000 on a waiting list.
The guide provides advocates with an overview of the authority governing Florida's Medicaid managed care long-term care waiver and a roadmap addressing basic questions including:
Jocelyn Armand, Legal Services of Greater Miami advocacy director, co-authored the guide with Harmatz, Katy DeBriere, co-director of the Florida Health Justice Project, and Michelle Adams, research assistant.
"The Advocate’s Guide is a much-needed resource for advocates and consumers alike. The guide’s road map helps navigate one of the most complex parts of the Medicaid program. We are extremely appreciative to the Florida Health Justice Project for the opportunity to collaborate on this crucial endeavor,” Armand said.
Anne Swerlick, health policy analyst with the Florida Policy Institute, endorsed the guide.
“This guide is an invaluable tool for Florida advocates seeking to ensure that consumer protection policies are implemented to protect Florida’s frailest residents,” Swerlick said.
Pro bono technical support for the guide also came from other groups, including Justice in Aging, a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources.
About the Florida Health Justice Project
A new nonprofit advocacy organization, the Florida Health Justice Project seeks to improve access to affordable health care for Floridians, with a focus on vulnerable low-income populations. FHJP expands the advocacy community’s capacity to resolve individual access issues and educate consumers; identify and address systemic barriers to healthcare; and protect Medicaid and other safety-net programs.
In past years, the Florida Legislature debated Medicaid expansion, the Senate passed expansion bills twice, and the state’s press corps-- given that they had something to “cover”—did a tremendous public service in helping Floridians better understand the costs and benefits of decreasing the state’s rate of uninsured. But for the last few years, health care policy debates have ignored Medicaid expansion and, instead, focused on different issues, including this year’s debate over whether hospital rates for safety net providers should be “enhanced.” Because respected Senate leaders, even within the same party, have opposing positions, it’s hard for stakeholders to understand which side to champion. Consumer advocates support critical safety net providers. But can they be supported through enhanced rates? What does that even mean??
Understanding hospital funding, is not for the feint of heart—particularly in Florida. Years of state cuts to the Medicaid program, including cuts to safety net hospitals, led to a confusing and arcane system of hospital funding. Adding to the confusion is that separate funding formulas for different hospitals exist within the state’s managed care system (referred to as “LIP” payments) as opposed to the specific rates that each hospital is assigned for the relatively few patients who are still in “fee-for-service” rather than managed care (referred to as “rate enhancements”).
In a nutshell, the Low Income Pool Program (LIP) provides a mechanism by which supplemental payments—separate and apart from regular managed care reimbursement rates—can be made to providers who treat a large percentage of uninsured patients. The state match for the LIP program comes through local funding sources, known as intergovernmental transfers, or IGTs, rather than general revenue; most LIP funding goes to safety nets and it is a defined amount. By contrast, a hospital’s “rate enhancements” represent a projection based on the rates paid by the State for patients in the fee-for-service system. Thus, under a managed care system, a hospital’s rate enhancement distribution can only be projected since it depends on 2 variables:1) the extent to which managed care company contracts with that individual hospital mirror the hospital’s “enhanced rate” agreed to by the State; and 2) the extent to which a given number of the managed care organization’s enrollees actually receive “enhanced rate” services at that hospital.
As a health care consumer advocate, I’ve spent significant time unpacking and explaining hospital funding so that stakeholders could better understand how the debates over hospital funding fit within the larger health care debate. Notwithstanding these by these efforts, I’m not sure I understand these issues well enough to “take a side” in the current Senate debate. But I do understand enough to note that the current debate isn’t raising the rights questions.
If we can agree that the goal of health care policy should be lowering costs and improving outcomes, two questions should be answered: 1) how can we get more people covered; 2) how can we ensure that coverage dollars are used to improve outcomes? The first question is easy. Unless/until most people are covered, the health care system as a whole (it is ultimately one system), will never be able to effectively control costs and improve outcomes. Because over half a million low income Floridians don’t have access to employer based coverage or coverage in the marketplace, the answer to the first question is simple: accept federal funding to pay for their care under the state’s Medicaid managed care program.
Answering the second question is much harder. But because Florida requires that virtually all Medicaid recipients receive their health care services through a managed care organization (MCO), we can begin. First, MCOs must receive a sufficient amount of funding in order to ensure that medically necessary services are adequately available to their enrollees. Because the federal government will reimburse Florida for roughly 60% of the MCO’s costs (for Medicaid expansion enrollees the federal government would pay 90%), Florida has to come up with a sufficient 40% “state match.” If we do that, theoretically at least, the MCO rates paid to providers will be high enough to ensure adequate provider networks for enrollees —from hospitals to doctors to therapists to midwives. Second, the state Medicaid agency must have sufficient funding to adequately monitor timely access to all medically necessary services.
But back to the safety net hospitals that treat a “disproportionate” number of patients on Medicaid. These patients are, by definition, low–income. It is undisputed that poverty and poor health go hand in hand and that it costs more for providers to treat patients who present in poor health. Additionally, Florida’s safety nets treat a large number of immigrants who are living and working here but who are not eligible for health coverage, even under Medicaid and the ACA. In short, Florida’s safety nets are critical and need to be supported. What is less clear is whether we do that through enhanced hospital rates.
Moreover, improving the health outcomes of low income Floridians means doing a lot more than increasing safety net reimbursement rates. As Maggie Kuhn observed, “the war on poverty has never been more than a skirmish,” and immigration debate in America may be even more contentious than the health care debate. But if Florida can at least address the first question and finally accept federal dollars to cover half a million uninsured Floridians -- we will free up some of the local IGT dollars now used to help safety nets cover the cost of treating the uninsured. Imagine the potential for improved health outcomes if, for example, some of those local tax dollars were freed up for more affordable housing and healthy food gardens?
By Miriam Harmatz, Co-Executive Director of the Florida Health Justice Project
Potential Budget Savings and Revenue Gains from Medicaid Expansion in Florida: A Snapshot Based on FY 2016-17
Written by Esubalew Dadi and published by the Florida Policy Institute. Re-published here with their permission.
A new Florida Policy Institute (FPI) report projects net state budget savings of a half billion dollars if Florida expands its Medicaid program. Under the Affordable Care Act, the state can tap into billions of new federal Medicaid dollars if it opts to cover more than 500,000 low-income uninsured Floridians.
Based on the experiences of other states and FPI’s analysis of FY 2016-17 data, the potential savings and increased revenues far exceed the additional costs that would accompany Medicaid expansion.
Savings and increased revenue would be generated through:
Medicaid expansion provides Florida policymakers an unprecedented opportunity to free up state resources that can be used to meet the pressing needs of our families, communities and economy. These include education, workforce training, affordable housing, roads and building sustainability into our coastal communities.
The Florida Health Justice Project, a new nonprofit advocacy organization, seeks to improve access to affordable healthcare for Floridians, with a focus on vulnerable low-income populations.
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