The Miami Herald reports:

A controversial measure that would shift $300 million in disputed Medicaid bills to counties has been received by Gov. Rick Scott’s office, triggering the 15-day window for him to either sign or veto the legislation. If Scott does neither by the March 29 deadline, it becomes law automatically.

via Clock ticking for governor to sign controversial Medicaid legislation | Naked Politics.

Some of questions asked by the Federal Government to the State of Florida regarding the transition to managed care for those on Medicaid. In a recent article some of these questions have been revealed.  If you were the State of Florida how would you answer them.

“The State must ensure that plans maintain a network of providers in sufficient number, mix, and geographic distribution to meet the needs of Medicaid beneficiaries,” one part of the list said.

“What are the standards that will be used by the state to ensure access to Medicaid services and to which managed care plans will be held accountable? How have these standards been vetted? Describe the ongoing oversight and review that will be in place to ensure plans maintain a sufficient network.”

via Feds Question Florida on Medicaid |

Florida Medicaid shift could take longer than expected | The News-Press |

Well written article, about the shift to managed care for seniors on medicaid and how the state and federal governments still do not understand how it will all work.  The need for independent advice on choices and care seems manifest for seniors and their families as these changes in the medicaid program are put in place.

The Miami Herald editorial page reviewed the Florida legislature 2012 session with a judgmental tone.  The editorial staff at the Herald were concerned that the legislature failed Neglected Elders and meaningful reform of the Medicaid Program.


Gov. Rick Scott and lawmakers talked a good game, calling for major reforms to improve assisted living facilities in the state. In the end, however, only the Senate was willing to impose serious reforms to help vulnerable ALF residents. But with no willing partners in the House and little leadership from the governor — who swore that this issue was a priority — ALF reform went nowhere this session. Shameful.


Jackson Health System dodged a bullet from the governor’s original proposal, which sought to cut a quarter billion dollars in Medicaid funding. Instead, the Legislature’s formula trimmed Jackson’s Medicaid allotment by about $47 million, with the ability to recoup about $12 million of that amount and possibly more through expected federal revenue.But even so, the Legislature forced Florida hospitals to absorb a cut of more than 5 percent in Medicaid funding in a state that already covers far less than what it costs to care for sick, indigent patients.Most maddening: The Legislature rejected $440 million from the feds to improve Medicaid reimbursement rates to physicians, money designed to encourage more doctors to serve the poor and disabled. This is all politics, designed to show displeasure over the Obama administration’s Affordable Health Act, but it winds up hurting Florida’s neediest.

via Missed opportunities – Editorials –

Forbes is reporting Long Term Care Issues are not a top issue for presidential candidates. An exception is Newt Gingrich. Forbes reveals:

Gingrich, who has shown real interest in long-term care issues in the past, was typically provocative though sometimes contradictory and often not specific. The former speaker used the survey as a platform to renew his calls for repealing the 2010 Affordable Care Act, turning Medicare from a guaranteed federal benefit into a defined contribution program, and replacing the existing Medicaid system with a federal block grant.

Gingrich said consumers should be able to use tax-advantaged Health Savings Accounts and Flexible Savings Accounts to buy long-term care insurance. This is somewhat curious since Gingrich has also proposeda flat income tax system that would seem to effectively end HSAs and FSAs.

Still Gingrich also said he’d “promote new models of care” that focus on primary medical care and home care. He also embraced the use of new assistive devices, though he didn’t say how consumers would pay for them.

In addition, Gingrich said Medicare should cover training for family caregivers. This is a very interesting idea through it is not clear how such a mandate would be implemented once Gingrich shifts Medicare to a largely private insurance model.

via Long-Term Care Services: Forgotten By Most Presidential Candidates – Forbes.

Local and County governments are on the hook for more cost sharing for Medicaid patients. Currently at stake is over 300 million dollars in disputed Medicaid billings. These funds owed are over a three year period.

p>The state wants to get that money, as well as future Medicaid payments, by withholding revenue sharing dollars from counties. That in an unfair burden on local governments that will hurt taxpayers, the Tea Party says.

“This is going to require counties to cut services or raise taxes to pay for what the state is mandating for the counties,” said Henry Kelley of Ft. Walton Beach, the Tea Party Network’s legislative liaison.

via Tea Party defends counties in Medicaid billing dispute | Naked Politics.

As Courts interpret Medicare and Medicaid laws, they ponder the language that the public policy is described in the laws. In todays Wall Street Journal JOE PALAZZOLO, writes about the difficulty in understanding the plain meaning of the enabling laws.

James Madison warned in the Federalist Papers about laws "so voluminous that they cannot be read, or so incoherent that they cannot be understood."

If only he had lived to see the Medicare and Medicaid programs.

via Here's a Funny Idea: Medicare Laws That Are Easy to Read –

As goes Florida so does Kansas.

Medicaid in Kansas has grown by 7.4% annually over the last decade, and Mr. Brownback would reform it by contracting with managed-care organizations to oversee and coordinate care. His plan would also provide monetary incentives for insurers and providers to improve quality and use health-care dollars more economically.But heres the rub. To execute most of these Medicaid changes, Mr. Brownback needs Health and Human Services Secretary Kathleen Sebelius to issue a global waiver, which frees the state from most Washington strictures in return for a cap on federal funding. George W. Bush granted Rhode Island a global waiver that has had excellent results, but Ms. Sebelius is a former Kansas Governor and may not want to give her party rival the power to succeed.

via Review & Outlook: Whats Right With Kansas –

What’s it show? It’s the hospitals — the hospitals that are behind the unchecked growth in state Medicaid spending, even though their rates have been cut and they’ve cried “crisis” year after year.

Florida’s one of only 10 or 11 states that pays hospitals a per-diem rate rather than a per-service rate. The hospitals themselves must submit cost reports to the state Agency for Healthcare Administration, and each hospital’s per-deim rate is set according to a complex formula.”

What’s behind Florida’s Medicaid spending surge: It’s the hospitals | On Call with Stacey Singer.

The Wall Street Journal reports on new resources for caregivers.

Home Instead Senior Care has started training its home-care workers in new techniques and strategies to improve care for dementia patients—and is starting to offer the same instruction at no cost online and in person to family caregivers.

“Families need help keeping their loved one safe and mentally engaged and stimulated, and managing difficult behaviors,” says Jeff Huber, Home Instead’s president.

To that end, Home Instead developed a life journal, designed to collect information about a patient’s history “to create a much more effective caring experience,” he says.

via Family Value: New Resources for Caregivers –

[Gov.] Scott said the reimbursement “adjustment” would create a flat rate for hospital groups using average costs. “No program has grown as fast and as much as Medicaid, and we must find a way to control the cost. If we do nothing, this program will bankrupt our state,”

via Florida plans to slash Medicaid funds ahead of health reform | Government Health IT.

In the Gainsville Sun Attorney Anne Swerlick writes “The Florida Legislature has an opportunity to address these problems. The state pays billions of dollars to mostly private-for-profit HMOs to care for some of the most vulnerable Floridians. It is imperative that these health plans provide Medicaid patients, their physicians and the public a transparent process by which health care decisions are made. This is especially important now as more Medicaid patients will be required to enroll in HMOs and other managed care plans.”

via Anne Swerlick: Will the Legislature protect Florida’s most vulnerable? |

RCPALM Editorial Page points out ‘Here’s what is particularly insidious about the Legislature’s proposed cuts to Medicaid: At the same time Florida lawmakers are planning to reduce vital health care services for hundreds of thousands of state residents, both chambers have approved state budgets that continue to offer overly generous health insurance premiums for high-ranking state officials. The governor, lawmakers and other powerful elites would remain eligible for health insurance premiums at significantly reduced rates — $8.34 a month for single coverage; $30 a month for family coverage. (By contrast, rank-and-file state employees pay $50 a month for single coverage and $180 for family coverage.)”

via Editorial: Florida Legislature’s proposed cuts to Medicaid too draconian; stakeholders must find reasonable solution »

Fred Grimm in the Miami Herald writes “If the Senate version prevails over a less Draconian appropriation in the House, 34 percent of the mental health funding, and 25.5 percent of the money for substance abuse, would disappear. Some 140,000 patients would be tossed from their community treatment programs. A number of these non-profit programs would shut down. (Even without the Negron cuts, the Department of Children & Families has admitted that it hasn’t been able to provide services to 170,000 adults and 40,000 children with serious mental illnesses.)”

via Commentary: Florida, this is insanity – Sacramento Living – Sacramento Food and Wine, Home, Health | Sacramento Bee.

The Tampa Bay Times reports use of a Yacker Tracker at Tampa Bays two veterans hospitals.  A Yacker Track “is a testing device that measure the decibel level on inpatient wards. Placed at nursing stations and looking like a red light signal, the device flashes red when the noise exceeds levels set by the hospital.”

VA hospital officials, it is reported, understand that noise can delay recovery and healing. Look for signs in the hospital that state “Quite please Patients healing.”

My research has always revealed that health care follows the money. So I was not surprised that the Insurance Company industry is profiting from the Health Law Mandate.  This is not a “bad profit” if coverage has high quality of care and high quality of life.

Bloomberg reports

The industry that was the loudest, most persistent critic of this law, the industry whose analysts and executives predicted it would suffer immensely because of the law, has thrived,” Gosselin said. “There is a shift to government work under way that is going to represent a fundamental change in their business model.

Panel Wrestles with Federal Rules for Health Funding
“The issue centers on a $1-billion-a-year program known as the Low Income Pool, which sends extra money to hospitals and other providers statewide that care for large numbers of poor and uninsured patients. The so-called “LIP” program was created as part of the pilot, which is controversial primarily because it requires most Medicaid beneficiaries in five counties to enroll in managed-care plans.

Federal officials agreed in December to extend the pilot through June 2014 but placed strings on how $50 million of the LIP money could be used. Those strings call for taking money that otherwise could go toward hospital services and requiring that it be spent on new or beefed-up programs to improve quality of care.”

CNN is reporting that  with Medicare reforms Doctors are going broke.  As a counter point, accountable care organizations start this month, Doctors may seek shelter in these practices. ACO may offer more compensation to those providers if they can keep patients  from needing expensive care.  This is part of great effort to rewrite our social contract of care. If all the doctors roll into ACOs and this approach fails then we will start to head in a single provider system.  We will need to keep an eye on this.

From PR Newsletter:

JACKSONVILLE, Fla., Jan. 5, 2012 /PRNewswire via COMTEX/ — Blue Cross Blue Shield of Florida (BCBSF) and the AmeriHealth Mercy Family of Companies (AMFC) today announced an agreement to enter into a joint venture to bring best-in-class Medicaid managed care and services to Florida beginning in mid-2012.

The joint venture, called Florida True Health, Inc., will be an equal partnership between BCBSF and AMFC. Both companies will share in the startup costs, financial risk and risk-based capital, among other business practices. Florida True Health will be responsible for Medicaid member enrollment, claims processing, provider network development, utilization management, quality management, customer service, community outreach, marketing, finance, actuarial and public affairs.

“This joint venture with AmeriHealth Mercy enables us to enter the Florida market with competitive capabilities from day one,” said Steve Booma, executive vice president of strategy and diversified business. “AmeriHealth’s exceptional operations and strong history in serving Medicaid members, combined with BCBSF’s 67-year history serving the health care needs of all Floridians, creates a unique organization dedicated to serve the state’s Medicaid population.”

Michael A. Rashid, President and Chief Executive Officer of the AmeriHealth Mercy Family of Companies said, “It is a privilege to bring our proven care management expertise to Florida. Our medical management and outreach programs have improved the health of our members for nearly 30 years. We look forward to working with the providers, community partners, the state and our BCBSF partner to make a positive difference in the lives of Floridians in need.”

Florida True Health will be headquartered in Florida, although the specific location of its offices has yet to be determined. Florida True Health will enter Medicaid as soon as state approvals are obtained.

About Blue Cross and Blue Shield of Florida

Blue Cross and Blue Shield of Florida (BCBSF) is a leader in Florida’s health industry. Since 1944, the company has been dedicated to meeting the diverse needs of all those it serves by offering an array of choices. BCBSF is a not-for-profit, policyholder-owned, tax-paying mutual company. Headquartered in Jacksonville, FL, BCBSF is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information concerning BCBSF, please see its website at .

About AmeriHealth Mercy

The AmeriHealth Mercy Family of Companies is one of the nation’s leaders in health care solutions for the underserved. AmeriHealth operates in 11 states and serves more than 4 million Medicaid, Medicare and SCHIP members through its Medicaid managed care products, pharmaceutical benefit management services, behavioral health services, and other administrative services. Headquartered in Philadelphia, AmeriHealth Mercy is a mission-driven company with more than 25 years of experience serving low-income and chronically ill populations. AmeriHealth Mercy’s divisions include:

Keystone Mercy Health Plan, a Medicaid managed care health plan servicing over 321,000 members in five southeastern Pennsylvania counties;

AmeriHealth Mercy Health Plan, a Medicaid managed care health plan servicing 108,000 members in 15 Pennsylvania counties;

Select Health, a Medicaid managed care health plan serving 214,000 members throughout the State of South Carolina;

MDwise Hoosier Alliance, a Medicaid managed care health plan serving 133,000 members throughout the State of Indiana;

PerformCare/CBHNP Behavioral Health Services, servicing almost 1.1 million members in Pennsylvania, New Jersey, Indiana, and South Carolina;

Perform Rx, a pharmacy benefits manager servicing over 1.8 million members.

The AmeriHealth Mercy Family of Companies also provides other administrative services in New Jersey and Kentucky.

SOURCE Blue Cross Blue Shield of Florida

Copyright (C) 2012 PR Newswire. All rights reserved

Health Care Reform has been attempted by seven presidents.  Obama’s administration with the Affordable Care Act, has put forth meaningful change. Even it’s detractors will state that it is legislation that is significant and can’t be ignored.  There is strong argument that this is a mixed public policy debate on how to spend limited resources and survive in the political arena.

Whoever provides medical care or pays the costs of illness stands to gain the good will of the sick and their families. The prospect of these good-will returns to investment in health care creates a powerful motive for governments to intervene in the economics of medicine. Political leaders since Bismarck . . . have used insurance against the costs of sickness as a means of turning benevolence to power. Similarly, employers often furnish medical care to recruit new workers and instill loyalty to the firm. Unions have used the same means to strengthen solidarity. To be the intermediary in the costs of sickness is a strategic role that confers social and political as well as strictly economic gains. Paul Starr, The Social Transformation of Medicine

The quote above is a bit stale in today’s marketplace of medicine. Health Care services will always follow the streams of payment from whatever sources are available.  With state governments unable to afford federal matching funds for entitlement programs the infrastructure of our community’s health care structure is truly at risk.

As the true cost of this health care infrastructure becomes more of a local government issue, limited funding may cause consolidation at the Hospital Level. Special Taxing Districts may increase to fund Hospitals.  As the debate becomes more local a closer look a medical outcomes and cost of care will be fought at our doorsteps. We need to be watchful of this issue.

In the Tampa Bay Times, Sue Brody the CEO of Bayfront Health System, has written an excellent editorial on health care reform. She states, “health care is experiencing a paradigm shift unrivaled in the last 25 years.”   According to Ms Brody providers have a tough mandate from the community and the government.  While noting that “providers are re-engineering processes to make way for increased access and improved quality at lower costs”, she warns of risks to the community’s quality of care due to drastic cuts from the state budget.  Large amounts of government money provide the funding for the poor who need specialized medical care.  This enables private insurance and their insureds to access medical specialist at their local hospital who were made available due to Medicaid funding. click here

Michael Porter a Harvard professor on strategy looked at Health Care financial waste and suggested that only a few centers of excellence exist and redundant facilities of care be closed.  There are more choices in the public debate, but we need to keep our eyes on this one.

On March 23, 2011, Governor Rick Scott established a commission to review whether government-run hospitals are in the best interest of taxpayers. He was motivated by a Florida Tax Watch report. This report show the rapid growth in hospital special taxing districts to pay for indigent care.

The Commissions draft report does highlight how concerned hospitals are over the medicaid reform approach the state is taking. The report did not suggest that public hospitals are not in Florida’s best interest.  Here is the pull quote from the report. It

The Legislature has also established timeframes for the Medicaid program to move to managed care for the vast majority of its recipients. This is to be completed for the individuals receiving Medicaid long term care services beginning July 1, 2012 and completed by October 1, 2013; and for Medical services by October 1, 2014—Implementation begins January 1, 2013.

In a managed care environment, health plans and hospitals will negotiate a rate. They are not tied to the Medicaid rate, but the Medicaid rate is normally used in the negotiations as a reference or starting point. Sometimes, it ends up being the negotiated rate. If the state moves to DRGs, questions will occur as to how this may affect the health plans/hospital negotiation and establishment of a rate, as well as how local contributions may be affected.

Health plans will be required to contract with “essential providers” that offer services that are not available from any other provider within a reasonable access standard. Statutory teaching hospitals, hospitals that are trauma centers, hospitals located at least 25 miles from any other hospital will be included in this group.
It will be essential that managed care companies selected by AHCA in the competitive procurement process for the new managed care programs receive a fair portion in the capitation payment for the cells that represent the hospital component for each individual. Providing a system where managed care companies and hospitals receive fair compensation is a major challenge that will need continued monitoring and development by the Agency and the Legislature. It has been a somewhat contentious battle between hospitals and managed care companies surrounding the rate issues. Hospital rate increases should not be implemented without coordination of the managed care rate for the new program to be a success.

Taking both reports together, it would seem likely that property taxes may increase to fund local indigent care in the public hospitals.  Keep an eye on this issue.

“At the state level, Gov. Rick Scott is trying to persuade the Obama administration to give Florida a waiver from federal requirements in return for Medicaid funds. The main issue is how to control the unmanageable costs — Medicaid now takes the lion’s share of the state budget — without shortchanging patients. The irony is that Republicans in Tallahassee condemn the federal healthcare overhaul for “rationing care” but they’ve devised a system that perforce rations care for Medicaid patients by putting them into managed-care systems.”

Politifact 2011 Lie of the Year.

When the journalist becomes the story, critics will state the myth of objectivity is exposed.  Politifact named the Lie of the Year Democrats claim of the end of Medicare. However, the program called Medicare will continue. For the Baby Boomers, however Medicare will be nothing like it is today. For a nuanced view, take a look at the NPR posting on the issue. Click Here

Watch carefully as the social contract for care changes to reflect the decision that our great society can not afford the health care we made available to our parents. Personal responsibility will be one of the main terms of the new social contract.  Phrases like “skin in the game” and “medical loss ratio’s”
will cause major shifts in political debate.  Social Media tools will also be exploited.  Fear and extreme examples will define the edges of the debate. 

Contrast with

Keep your eyes on the spin factor as the fallout of CMS approval of Florida’s Medicaid Waiver expands.  The Heritage Foundation post on Medicaid Reform shows how the politics of reform can be hyped.

Florida’s Medicaid Reform Pilot is pro-patient and pro-taxpayer, and the Obama Administration agrees. ….The Florida reforms work by giving patients a choice of the private health plan that works best for them. Enrollees can choose from plans with varied benefits and provider networks, and a monetary rewards system creates incentives for healthy, responsible behavior. By shifting away from failed policies of central planning toward a consumer-driven program, the program has been successful on a number of levels.

Compare and contrast to Floirda CHAIN. Florida CHAIN is a statewide consumer health advocacy organization.

“The message sent today by the Administration is clear: insurance companies will be held accountable and there’s no way around it. The decision by HHS sends a strong message that the important consumer protections in the ACA can’t be stripped away, regardless of maneuvers by insurers to boost profits or by state leaders to push a political agenda. “Individuals and families in Florida are expected to gain up to an additional $70 million in health insurance rebates, which is anticipated to be paid out by August 2012. We are thrilled to be able to report this huge victory for the hard-working people of Florida, who stand to gain money saved in their health care premiums and peace of mind that they’re health care dollars are being spent to keep them healthy.” click here for full report

Insight can be gained on the Obama Administration response itself.  As Forbes reports:

The Department of Health and Human Services has denied the State of Florida’s request that they be permitted a waiver to the medical loss ratio requirements of the Affordable Care Act.

Rather than live with the 80 to 85 percent requirements established by the health care reform law, Florida had asked for an adjustment that would allow insurers to meet the signficantly lower thresholds of 68 percent in 2011, 72 percent in 2012 and 76 percent in 2013. Click Here for full report

So as the groundwork of private insurance for medicaid patients is established in the state of Floirda, all parties are fighting for how much profit can be in the system to administer the program and adjust to the risk of utilization of services.  If private insurance can in fact step up and provide mandated services in a more efficient manner, they will be fighting a steady retraction of funding per patient as the Baby Booms start into the long term care system.  With limited financial reward for improvement, then it stops being true insurance and becomes “dollar trading”. Dollar Trading will result in significant limits in profitability and shareholder value.  The public policy debate will continue to twist the politics of Medicaid Reform.

For those clients seeking Medicaid at this time, the value of good advice can be very helpful.  Understanding the changing landscape of care and how families will be asked to contribute more financially is a radical shift from the Medicaid of the past.  With proper planning clients can have more choices and a better understanding how the system works. Once the impact to famlies is understood a more nuanced discussion can take place.  Until then, more shouting from both sides is needed to create well thought out solution to Long Term Care.

Pull full article from the Floirda CHAIN website:

Greg Mellowe, has an expansive post explaining the extension of Florida’s Medicaid Reform Experiment.  Although the posting is broader than just senior issues, to is one of the clearest statements of the current Medicaid Reform. A few of the points raised in the agreement between CMS and the State of Florida are below.

* Obtain federal approval for any type of expansion of Medicaid managed care beyond the five Pilot counties. Florida has such a request pending at this time.

* Spend at least 85% of taxpayer-funded Medicaid payments on direct patient care or direct care quality improvement activities.

* Set a well-defined minimum standard for plans to provide Medicaid benefits that meet the needs of at least 98.5% of enrollees. Plans may not reduce benefit levels below this minimum standard.

* Prevent disruptions in patient care, particularly those caused by plans in the past. Florida must take steps to prevent plans from pulling out of any geographic area. The State must also use a detailed procedure to ensure continuity of care for patients when they’re forced to change plans.

* Hold managed care plans more accountable to ensure access to and quality of care.

– must set, justify, and enforce standards for plans, including standards for provider network adequacy and access to care.
– must ensure that the patient-level “encounter data” that has been promised for more than five years is collected, analyzed, and used to monitor health care access and quality.
– must receive federal approval of any process used to select and negotiate with managed care plans as well as plan contract documents.

* Allow most recipients who do not have a choice of at least two managed care plans to enroll in the MediPass program (or regular fee-for-service Medicaid).

* Improve its choice counseling efforts, not reduce them. Florida must not only continue its choice counseling activities to help patients make informed choices, the State must also perform activities that were supposed to have been doing since 2006, including increasing health literacy and reducing minority health disparities through outreach. Choice counseling must also use a plan rating system.

* Apply the same rules for determining eligibility and requiring co-payments in any Medicaid managed care experiment that apply elsewhere in Medicaid. The State cannot use the flexibility of the Medicaid waiver to jack up co-pays, demand payment of premiums, or restrict who can qualify for Medicaid. In other words, the State cannot use the waiver to evade the basic protections of Medicaid.

The Wall Street Journal, today, states on its editorial page the definite and imperative need for Medicare reform in one sentence. “The brutal math is that Medicare spending has been growing about three percentage points faster every year than the overall economy for the last quarter-century and is now the main driver of the financial crisis.”  Legislative leadership is shifting to a stipend approach.  This may cap the Federal Government’s financial exposure.  With a stipend one often finds not enough payment to cover the choice you prefer. 

How will Health Care marketplace respond to this change of focus? How will consumer directed care be better served?

These questions and many others will reframe the debate about health care entitlements.  It is probably time to reframe the debate, the boomers are not their parents elders.  Choices and alternatives to traditional long term care approaches are desired by the boomers.  Life style and personal preferences are key to the boomers making these choices.  As the role of the patient changes into a health care consumer the market place and pricing for care will respond.  The Boomer who desires to create a supportive care environment that does not financial exhaust may find satisfaction with the flexibility that a market driven choice could provide.

Keep you eyes on the ball, the politics of Medicare is an interesting game.

Medicaid pays for 75% of total Nursing Home Care costs through the Institutional Care Program. The State of Florida pays only 35.17% of this expense, the balance is paid for by the Federal Government. The 35.17% share of cost, however, has become one of the most expensive items in the state budget.

Lawmakers in the state have demanded a cap of future growth in Medicaid budget despite decades of annual increases.  The State of Florida also seeks to control not only its Medicaid Nursing Home costs but its total share of cost for Medicaid Care in the Community.

In the past Florida received a small amount of funding under a program called Money Follows the Person.  The Federal Government was offering a federal grant of $35.7 million to enlarge choices other than nursing home for frail elders.  Despite work by several state agencies and disability support groups, Florida will not receive a federal grant of $35.7 million. 

“Not only would accepting the Money Follows the Person grant go against our policy of implementing federal health-care reform, but it would be redundant to the multiple efforts that Florida has already made to improve the delivery of long-term care,” said Rep. Denise Grimsley, R-Sebring, chairwoman of the state’s House Appropriations Committee. Source Orlando Sentinel

This is reminds me of the book Whats the Matter with Kansas. . The federal grant would have only cost the state $627,963. $35.7 million would have created a lot of jobs and services that would have been delivered to the citizens of Florida. This was done to consolidate all efforts into the medicaid reform waiver. 

A key aspect of the medicaid reform waiver is to incentivize insurance companies to manage the care of all florida nursing home residents and those seniors in the community on medicaid. Profits for the insurance companies will also result in a huge savings for the state. As the boomers reach out for nursing home care, other choices may be available, that do not fall under a government entitlement.  This will result in more personal responsibility within the extended family.

So Floridians will not have a slow exodus from Nursing Home Care. It will be a dramatic change resulting in nursing home care for those who need only the most acute care.

Jack M. Rosenkranz

12/08/11 © Health News Florida

Gov. Rick Scott’s proposed budget would inflict particular pain on hospitals that treat large numbers of Medicaid patients, but the amount of the pain varies.

A preliminary analysis from the Safety Net Hospital Alliance of Florida, updated Thursday afternoon, indicates the hardest-hit would be Jackson Memorial, at $133.5 million.

Next-highest is Shands Hospital at the University of Florida in Gainesville, with estimated losses of more than $60 million.

Here is the updated list:

–Miami Children’s: $34.4 million

–All Children’s, St. Petersburg: $38.9 million

–Shands-Gainesville: $51.8 million

–Jackson Memorial, Miami: $133.5 million

–Mount Sinai, Miami Beach: $237,749

–Shands-Jacksonville: $13.6 million

–Tampa General: $32.5 million

–Orlando Health: $937,187

–Broward Health, Fort Lauderdale: $42.2 million

–Memorial Healthcare, Fort Lauderdale: $58.4 million

–Lee Memorial, Fort Myers: $20.9 million

–Sacred Heart, Pensacola: $3.7 million

–Bay Medical, Panama City: $2.6 million

–Sarasota Memorial: $9 million

–Halifax Medical Center, Daytona Beach: $2.8 million

Medicaid rates vary within a community because hospitals that offer specialized levels of care, such as trauma centers and neonatal units, have higher average costs.

The Rosenkranz Law Firm has sought to shift Vets from Medicaid to the VA health care system for almost 15 years.  In a rare press release on the topic Kaiser Health News reports:

“It is commonly accepted that many poor veterans and their families find themselves on Medicaid, even though, in many cases, they would qualify for more generous benefits from the Department of Veterans Affairs.

The VA’s Aid and Attendance program, for instance, helps wartime veterans receive the care they need to stay in their homes or assist with long-term care expenses. But many who are entitled to this benefit end up on Medicaid — which has significant implications for the veteran’s family members.

In 2003, the state of Washington began a pilot program to identify veterans who were falling through the cracks. In the years since, the program has served thousands of people who qualified for this assistance. At the same time, it has helped relieve some of the fiscal pressure placed on the state’s Medicaid program by shifting these costs to the federal VA. Viewed as a win-win, the program has become a model for other states.

KHN asked two state officials invovled in the program’s operations to explain the basics of the Veterans Benefit Enhancement Project — how it came to be and why it is making a difference for both the state’s veterans and its budget. Commentaries follow from Bill Allman, who developed and now manages the Washington State Health Care Authority’s program, and from Alex Deluao of the Washington State Department of Veterans Affairs.

How PARIS Is Helping Veterans In Need

Bill Allman writes: “About 10 years ago, I first heard about a federal databank called PARIS — the Public Assistance Reporting Information System. … Astonishingly, a broader use of such a databank had gone unrealized until I started asking questions, particularly about the military and veteran program information available to the states. With my background in medical assistance for the state of Washington, I was well aware of the fact that many poor veterans and their families were winding up on the rolls of Medicaid, never realizing that they might also be eligible for richer federal benefits.”

For more information click here

On Dec 6 2011, Shirley S. Wang writes that there is some evidence that lefties “are better at divergent thinking or starting from existing knowledge to develop new concepts, which is considered an element of creativity.”  In the next paragraph, however, she raises the point of a higher risk for schizophrenia. 

Left handed people are only 10% of the population. Research has been done linking handedness and the development of the brain.  The research is not conclusive at this time, however one pathway of prenatal stress is cortisol.  Several studies show that pre natal issues of stress of life events of the mother result in cortisol being released into placenta barrier to influence the baby. 

So is it possible that a left handed child is born with increased divergent thinking as a biological defense against a hostile world perceived by the mother? 

For the article: Click here

For a video on how left handed and right handed people differ: Click here

April 28, 2011

TALLAHASSEE, Fla. – Basic health security for seniors, the poor and people with disabilities would be privatized under a Republican plan pending in the Florida Legislature.

Laura Goodhue, executive director of the Florida Community Health Action Information Network, takes issue with the plan, outlined in Senate Bill 1972.

“The main goal is to move all Floridians that are on Medicaid into privatized care, into privatized plan networks.

Goodhue underscores Florida’s dependence on Medicaid and says a pilot program to move people into a private health maintenance organization has not received rave reviews.

“Our organization has looked at various aspects of the pilot, and our conclusion is it hasn’t worked and people have really suffered.”

Republican lawmakers say the measure is needed to keep the state from sinking even further into debt.”

Florida state records show almost 3 million Floridians rely on Medicaid. Goodhue believes Medicaid privatization backed by Gov. Rick Scott is a bad idea, and the federal General Accounting Office says the efforts by Florida lawmakers to shut down expansion of Medicaid set for 2014 would deny coverage to millions of needy Floridians.

Les Coleman, Public News Service – FL

The medicaid transition program is one of Florida responses to the US Supreme Court case named Olmstead.  The Olmstead case brought ADA rights to those in nursing homes paid for by Medicaid. I find it important to recall the Haddad case from the Jacksonville US District Court.  In the Haddad case an adult who was disabled living at home, refused to wait 60 days of residing in a nursing home. She argued that she would lose her supportive care network that had been established for years if she relocated.  The federal court found her pleas had merit and ordered the state to provide the transition program.  Currently Florida Citizens are forced to wait for care in the community. The Rosenrkanz law firm seeks to be creative during the 60 day wait for Transiton.

Florida among states cutting costs by limiting Medicaid hospital coverage
By Ashley Lopez | 10.24.11 | 1:58 pm
The Florida Independant

Kaiser Health News and USA Today report that Florida is among a slew of states that have been cutting costs by limiting hospital coverage in their Medicaid plans. Last week, an official for Florida’s Agency for Health Care Administration suggested that the state further cut coverage to a maximum of 12 emergency room visits a year for each Medicaid beneficiary.

Arizona and Hawaii are currently waiting for federal approval of their plans to cut hospital coverage in their plans, much like Florida already has.

“Advocates for the poor and hospital executives say the moves will restrict patients’ access to care, force hospitals to absorb more costs and lead to higher charges for privately insured patients,” Kaiser/USA Today reports. “States defend the actions as a way to balance budgets hammered by the economic downturn and the end of billions of dollars in federal stimulus funding this summer – funds that had helped prop up Medicaid, the state-federal health insurance program for the poor.”

Florida is already among the list of states that have limited hospital coverage for Medicaid recipients in an effort to cut costs. The state’s Mediciad program currently only covers 45 days in a hospital for its beneficiaries.

Last week, acting Medicaid director Justin Senior told a Florida House health care committee that the state “could reduce home health visits for Medicaid beneficiaries and slash the amount of inpatient hospital care the program covers,” The News Service of Florida reported.

Senior said the state could limit emergency room visits to a maximum of 12 a year for each Medicaid recipient, which he said could save the state $12.2 million.

State Rep. Janet Cruz, D-Tampa, raised concerns for terminally ill patients who typically need more hospital visits. However, other members of the panel were “receptive” to the idea, the News Service reported:

Chairman Matt Hudson, R-Naples, said such a move could drive people to get treatment from primary-care doctors instead of emergency rooms, which could improve their health care.

Rep. John Wood, R-Winter Haven, appeared miffed that some Medicaid beneficiaries might go to the emergency room more than once a month, calling it “unacceptable.”

“If we’re allowing that type of behavior, shame on us,” Wood said.

Health advocates for low-income people are among those opposed to plans by states to limit hospital coverage for Medicaid patients.

Kaiser and USA Today report:

In Alabama, which has had a 16-day limit for more than decade, hospitals have billed patients for days not covered by Medicaid, said Larry Gardella, director of advocacy at Legal Services Alabama. Because poor patients often are unable to pay, the hospitals typically must pick up the cost, he said.

Another problem: Patients may also delay seeking elective services if they’ve already reached the coverage limit, Gardella said.

The state Legislature made significant cuts to the Florida program in the past year. Hospital coverage has been just one of the services that has been limited for Medicaid beneficiaries as the state aims to cut costs.

From an extensive report by Families USA:

“Medicaid makes it possible for Floridians to get the care they need. People with Medicaid have better access to health care than do the uninsured. A recent study that used a randomized, controlled design—the gold standard in medical research—found that, compared to the uninsured, people with Medicaid had better access to outpatient and hospital care and prescription drugs. They were also more likely to have a regular source of care.  For people with serious health care needs, having access to care and having a regular source of care can improve health and lower rates of costly, and sometimes deadly, complications, or it can keep a disease from progressing.”

For the full report.

By Jack M. Rosenkranz, J.D.

How do we imagine the aging experience?  What will it be like for us and how will we know what to do when our aging parent requires our help?  Howard Gleckman attempts to answer these questions in his new book, Caring for our Parents, published this year (2009) by St. Martin’s Press.  Gleckman collects stories of aging adults and their families who are navigating their way through the complicated and fragmented long-term care system.  Most of the aging adults in Gleckman’s text suffer from Alzheimer’s; their children find themselves caregiving and searching for care and services that are difficult to organize even when family members have the ability to pay for them.  The loved ones of these aging adults do not know where to turn as they are faced with the challenges of choosing appropriate care and of having multiple insurers, providers and funding sources.
As the population ages, more Americans will be faced with taking care of their aging parents and making sure that they themselves will be taken care of in their twilight years.  While the book provides numerous important references for adults taking care of an aging parent, it illustrates that caring for our parents is complicated and often requires an insider’s knowledge of the health care system.  Gleckman’s illustrations are cautionary tales about the importance of getting help when maneuvering through the long-term care system.  None of the families in his text seem to know beforehand that the aging process can be tailor-made with the help of individuals experienced in the health care process. 

This headline ran over a Wall Street Journal article about rationing of health care in Canada.  It offers a sad outlook if the US Health Care System follows the Canadian “Too Old for Hip Surgery” model.  Preventive care will be the focus of the future.  Quality of Life depends on having a supportive and conscientious environment within which to age.  Recognizing the risks in the American system, scholars and policymakers have begun to differentiate between the fundamental causes of healthcare disparities – access, education, poverty – and patient level disparities.  Scholars Peter Franks, MD and Kevin Fiscella, MD use the term “downstream reforms” in an effort to describe the disparities that occur at the patient level.  In the January 2008 edition of The Journal of Internal General Medicine, they highlight downstream reforms that are important to improving the health care for the chronically ill. 
These Doctors argue that disparities can be addressed by examining both the provider-patient interaction and the manner in which clinical decisions are made.  Much of their discussion centers on what individual doctors and patients can do to change their own biases and actions.  The Baby Boomers are moving to individualize health care where personal preferences, desires and comfort are often just as important as clinical factors.
Until widespread reforms are made that affect physician and clinical decision-making, elders and their families will need to implement their own downstream reforms through self-education and advocacy to improve care and prevent disparities.  The Rosenrkanz law firm may be able to help build a supportive care environment that does not financially exhaust the family.

Many elders are concerned about the existing and potential disparities in the American health care system.  One’s quality of life depends on having a supportive and conscientious environment within which to age.  Recognizing the danger that healthcare disparities represent in the American system, scholars and policymakers have begun to differentiate between the fundamental causes of healthcare disparities – access, education, poverty – and the disparities that occur at the patient level.  Scholars Peter Franks, MD and Kevin Fiscella, MD use the term “downstream reforms” in an effort to describe the disparities that occur at the patient level.  In the January 2008 edition of The Journal of Internal General Medicine, they highlight downstream reforms that are important to improving the health care for the chronically ill – something that is of disproportionate importance to elders. 
Franks and Fiscella argue that disparities can be addressed by examining both the provider-patient interaction and the manner in which clinical decisions are made.  Much of their discussion centers on what individual doctors and patients can do to relieve their own biases and actions that result in healthcare disparities.  They explain what is part of a larger effort to individualize health care where personal preferences, desires and comfort are often just as important as clinical factors.
While elders experiencing a chronic illness find themselves in difficult situations because health care knowledge and information are often limited, physicians are not always able to individualize care to patient needs because their information about patient preferences and lifestyle are also limited.  Until widespread reforms are made that affect physician and clinical decision-making, elders and their families will need to implement their own downstream reforms through self-education and advocacy to improve care and prevent disparities.  With Health Care Advocacy, the Rosenkranz law firm is dedicated to helping elders and families in this process. 

What do individuals in all health care environments desire: to live comfortably without pain.  This is of particular concern to aging adults who suffer from conditions with chronic care more than any other population.  A recent study in the journal of Pain Medicine examined the nature of patient-directed care and the patient-provider relationship for aging adults seeking treatment for chronic pain.  Conducted by Dr. Carrie Teh and her cohorts, the study examined the experiences and desires of fifteen older adults in the Pittsburgh area.  Researchers found that while some patients wanted to be told what to do by their physicians, others wanted to actively participate in efforts to manage their pain.  These participation efforts included refusing specific undesirable treatments and demanding quality care.  Regardless of the degree of control patients wanted in their pain decisions, all patients described the importance of being both “heard” and “understood” by their health care providers. 
There are two crucial implications of this study.  First, patient-centered care is becoming the norm.  Second, aging adults, regardless of the role they want to play in health care decision-making, want to feel connected and heard in the health care process.  What the study also indicated was that, some patients may not be entirely ready for this but still want quality care.  Nonetheless, the ability to be involved represents an important opportunity for elders and their families. 
Elders and their families have the ability to be the first generation to actively participate in the health care process.  This will pave the way for other generations to become partners rather than their observers in their health care.  The Rosenkranz law firm is dedicated to provide resources wherein families can get help and manage the care process.  Building a supportive care environment that does not financially exhaust the families resources may be a result that could be obtained.  What are your families goals and preferences.  Contact Jack Rosenkranz for more information on this topic. to assist individuals, to determine for themselves, elder goals and preferences.  For more information, please contact Informed Elder Institute, Inc. at 813-223-04195

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