GUEST EDITORIAL: Medicaid policies remain big issue in Election 2016

Staff Writer
The Destin Log

EDITOR’S NOTE: This guest editorial is from the Sarasota Herald-Tribune, The Log’s sister paper with GateHouse Media.

While Medicaid is a federal-state partnership for low-income Americans, states have wide latitude to set reimbursement rates and, as Florida has done, they can pay private-sector, managed-care companies to administer the plans.

Floridians deserve a good return on their investment in these plans and, most important, children should receive prompt, high-quality care. Medicaid covers 42 percent of all Florida’s children.

Evidence in a class-action lawsuit, which Florida agreed to settle by promising “improved quality outcomes and higher standards of care,” combined with a recent survey of pediatricians and reporting by journalists point to problems that need solutions. Two recurring themes are:

• Low payments, even by government standards, to physicians and other health-care providers for services rendered.

For example: Medicaid in Florida pays a pediatric provider $69 for treating a critically ill child; Medicare, the federal program that covers most seniors, pays $146 for the same type of visit.

• Reassignment of children to new plans or doctors without their knowledge.

In light of these themes, there are two major questions:

• Should Florida prohibit reassignments unless parents are notified in advance and a state agency approves the change based on specific criteria?

• Should Florida raise its children’s Medicaid payments to reach parity with Medicare, the federal program for nearly all seniors?

As we wrote in June, two-thirds of the 131 pediatricians who responded to a recent survey reported an increase in patients who had been unknowingly reassigned. Although the 6 percent survey-response rate was low, it underscored anecdotal evidence and was significant enough to raise red flags.

Florida agreed to address this problem in the lawsuit settlement; state administrators and legislators should closely monitor compliance.

Whether the rates are for the treatment of someone’s critically ill child, or pediatric dental care, Florida consistently ranks at the bottom, among all states, in reimbursements. The record, underscored by basic economics, is clear: There is a strong connection between payment rates and access to physicians willing to provide good care.

Florida has committed in court to improving access and outcomes. Candidates in the current election cycle must agree.