Psychiatric patients need Medicaid, advocates argue
State workers don't know if there are any records on plans to reform Medicaid.
By ALISA ULFERTS
Published March 31, 2004
TALLAHASSEE - Mental health advocates pleaded with lawmakers Tuesday to scrap a plan to shift hundreds of thousands of Medicaid psychiatric patients into HMOs, predicting serious consequences if it happens.
The plan is intended to save money, but how much is unclear. House staff hasn't calculated the savings and Gov. Jeb Bush isn't recommending it.
Mental health advocates, however, said the real cost of moving patients into "profit driven" HMOs could be the harm caused to the people the state is supposed to help.
"It means denial of services. It means denial of treatment. It means homelessness. It means loss of lives, figuratively and literally," said Michael Mathes, Florida president of the National Alliance for the Mentally Ill.
Steep cuts proposed in social services have special interests jostling for money. A big reason for those cuts are skyrocketing Medicaid costs. Prescription drugs are a culprit, and mental health drug costs are increasing three times faster than other drugs.
The advocates who spoke up Tuesday said they are afraid that service for mental health patients is taking a back seat to politics. They point to Wellcare as an HMO that has been involved in crafting the plan for the switch. Wellcare has poured thousands of dollars into the campaign of House Speaker Johnnie Byrd, who is running for U.S. Senate.
"It appears that he is heavily invested in HMO issues," said Bob Constantine, director of the Florida Council for Behavioral Healthcare. "But I don't want to say that it's related to campaign contributions."
When asked about the House bill, Byrd said he wasn't familiar with it.
"I don't know what language you're talking about. I certainly think the managed care industry is part of the solution to managing and containing the cost of health care and making sure it's delivered in a way that helps the most people with the best procedures," said Byrd, R-Plant City.
Mental health advocates estimated about 550,000 Medicaid patients would be immediately affected.
Although most Medicaid patients are in HMOs, mental health and substance abuse services are covered under a separate - and expensive - fee for service arrangement.
People who provide mental health services say this is the best way to ensure that people with mental illness or substance abuse problems get the help they need.
"How can we expect a person with a brain disorder ... to jump through the hoops and barricades set up by an HMO?" Mathes said.
But a paragraph quietly inserted into a House bill would require Medicaid HMO patients to get those services through an HMO.
That's been tried the past few years in several counties, including Hillsborough, as an experiment.
Annual studies commissioned by the state suggest that fewer dollars get spent on actual care when mental health and substance abuse services are in the hands of HMOs.
A spokeswoman for the Agency for Health Care Administration said it hasn't calculated potential savings from the plan because it is not recommending it this year.
The language isn't included in the Senate's Medicaid bill, so it could become a matter of dispute during budget negotiations next month.
But lawmakers who support the change say it will save money and that Medicaid HMOs have pledged more accountability about actual care.
"Nobody wants quality of service to deteriorate," said Rep. Sandra Murman, R-Tampa. "But we've got to look at the big picture."
Besides, new Medicaid patients can choose between an HMO or a traditional network when they sign up, and the other network isn't affected by the change, Murman said.
Mental health providers upset about the proposed switch to HMOs are "afraid that they are just going to be locked out of this market," Murman said.
Gary MacMath, president and CEO of the Boley Center for Behavioral Health in St. Petersburg, said the change could cost his center $1.5-million. That would force him to eliminate beds and he already has a waiting list of 100.
Even though mental health care providers ended up signing on with HMOs in Hillsborough during the state's pilot project, MacMath said he's not confident that would happen in Pinellas.
"It wipes us out of the equation."
- Times staff writer Steve Bousquet contributed to this report.
