Technological innovations are changing the way that patients, particularly the chronically ill, receive health care.  Patients are becoming responsible for coordinating more of their own care.  One example of this increase in responsibility is the use of remote patient management technologies – video conferencing between physicians and patients – by the Veteran’s Health Administration (VHA).  Veterans with chronic illnesses can now consult with their physicians remotely, which makes care less expensive and allows patients to individualize their care with less reliance on medicine and more focus on non-medical assistance.  The VHA’s use of remote patient technologies has been so successful that the Centers for Medicare and Medicaid implemented remote patient management for a portion of the Medicare fee-for-service population.

            As internet, audio and video conferencing and other technological innovations become more frequently used, patients will have to change their behavior and become educated on how to play a greater role in their care.  A recent study of the strengths and weaknesses of remote patient management suggests that one of the core tools are becoming available to patients require in this new era of health care delivery non-medical coaches.  In their recent Health Affairs article, Molly Cote, Ateret Haselkorn and Steven DeMello recommend coaching, what they describe as “motivational interviewing and other techniques to encourage patient behavioral change and self-care.”  The Rosenkranz Law Firm works with 3rd party vendors to help our clients build a supportive care environment that meets their families needs. This may result with families are receiving the individualized health care that they require at an affordable cost.  Many elders and their families have found Brook Crumrine our care coach to be of great help.  Clients of the firm report be able to meet the expectations of a health care system that is requiring that patients take more responsibility for the quality and coordination of their own health care.

Friday, June 10, 2005
Governor Bush Signs Changes To Medicaid
Welcome to!

On Friday June 3, 2005 Governor Jeb Bush Signed legislation that will allow him to roll out his new plans for Medicaid as a test project in both Duval and Broward County where nearly 300,000 Medicaid recipients reside. The Governor has proposed an aggressive schedule that includes having his program active statewide by 2006.

No matter your political position; contact your local legislator and let them know how you feel about these issues. The future of Medicaid is changing. It is up to every one of us to ensure our voice has been heard before law makers enact these changes.

Have a great weekend!

Jack Rosenkranz, JD

posted by Jack Rosenkranz @ 8:30 AM 0 comments

Friday, June 03, 2005
Highlights From The First Rosenkranz Report
Welcome to! I hope you have all had a wonderful memorial day weekend.

When the Jeb Bush released his plans to alter Medicaid in the up and coming year, I took action. I consumed a tremendous amount of time researching the governor’s plans, alternatives, the key players involved, and all articles that had been released on the subject in the year before the governors first official release. We have seen a tremendous amount of political activity in Tallahassee since that first release in January. I have followed these events with cautious optimism. I have released a series of reports over the last six months entitled, “The Rosenkranz Report.” I am posting some highlights from the first Rosenkranz Report, and will publish them in their entirety on this web site in the months to come. Thanks!


In his continued effort to support the elderly of the great state of Florida, Jack Rosenkranz of Rosenkranz Law firm has come across information that is of unparalleled importance to you. In early January of 2005, Governor Jeb Bush (R-Florida) released a proposal for overhauling Medicaid. He is calling for many changes to the system that will greatly affect everyone who has a stake in the future of Medicaid.

The wheels are already turning. A joint committee on Medicaid reform composed of some thirty Senators and Medicaid experts toured Florida taking public suggestions for changing the system. It has become evident that something needs to change: at the current rate of growth, Medicaid spending will consume more than 60% of all spending by the State of Florida. Lawmakers are not going to allow this to happen. There are other important programs that also require money: education, safety, highways and roads, just to name a few. Medicaid currently costs more per year than any of these programs.

So what is going to change? Governor Jeb Bush has proposed dramatic alteration to the system. To summarize: if the governors original plan passed today, people on Medicaid would be assigned a counselor to help them pick the type of health care they want. Recipients would then be given money to help them purchase private insurance. Some sort of co-pay structure would likely be involved. This proposal assumes that the majority of Medicaid recipients will participate and have the ability to make good choices about their medical care. Jack Rosenkranz believes, after years of experience working with the elderly, that many people will be intimidated by the system and not use it at all. He is also concerned about elderly people with dementia and other cognitive impairments. How would these people be protected to ensure that they are not overlooked by the system?

Rules of eligibility to obtain Medicaid benefits are being challenged and reworked to drastically altering the look back times to obtain benefits. Some proposed changes would remove two of the three tests for determining eligibility and rely totally on household income. The new system would also factor in a portion of assets for determining eligibility. Basically, the higher a persons combined income/asset level is, the less likely they will be to qualify. Removing the Medicaid annuity is also being proposed, which will reduce benefits for some people.

Yet another proposal suggests creating a Medicaid HMO; a model that many of you are familiar with from experiences with Medicare HMO’s. This would undoubtedly bring about the same cumbersome aspects of accessing medical care and obtaining prescription coverage Medicare recipients experience. Recipients will have to travel from doctor to doctor to get specific types of care and deal with the limits associated with insurers making medical decisions. This is just one option that has been looked at.

The most disturbing aspect of the governors proposal involves giving recipients the chance to obtain coverage rather than entitlement to coverage. Basically, having entitlement gives a person a legal right to the money allotted by Medicaid. If you have the opportunity to obtain coverage and the funding is not there, you would be out of luck. You could not sue to get the money because you would not be entitled to it. Entitlement also ensures that medical facilities get paid. Without entitlement, businesses would have no legal recourse and many would become insolvent in a short time.

Jack Rosenkranz is following these proposals with cautious optimism. None of these things has happened yet. Legislators are still in the planning process. So what does this mean to you? Medicaid is going to be overhauled in the next year to eighteen months. Florida lawmakers are going to take action to change Medicaid. What will change and to what degree remains to be seen.

posted by Jack Rosenkranz @ 6:48 AM

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