Cutbacks may shut down clinic
By RYAN DAVIS
© St. Petersburg Times, published February 18, 2001
NEW PORT RICHEY -- Daniel Miller relies on the Pasco County Health Department for life-saving medications.
He and his wife, Sandra, are able to afford prescriptions for heart and diabetes medications only because state-provided aid lets the countyoperate a sick-care clinic.
But that aid may vanish if the Florida Legislature approves proposed cutbacks. Without the aid, the clinic may disappear.
"If we don't come, it's my husband's life, possibly," Sandra Miller said.
The state agency overseeing health care is sympathetic to the plight of families like the Millers, but their access to affordable medical coverage could be sacrificed as a side effect of its money-saving proposal.
"It is a concern," said Connie Ruggles, a senior management analyst for the state's Agency for Health Care Administration, which oversees Medicaid. "However, when you look at the picture as a whole, it represents a considerable savings to the state as a whole, and that's really the way we have to look at it."
In the proposed budget before the Legislature, the agency has recommended privatizing the Medicaid coverage of 350,000 people, including several thousand in Pasco County. They say the move would save $67-million by transferring those patients to more restrictive, private HMOs.
No one is certain what's going to happen. But the plan's critics are tossing out scary scenarios.
It's not the patients who will be transferred to the private HMO that critics are concerned about; it's the uninsured patients they're concerned about. People like 42-year-old Sandra and 49-year-old Daniel Miller benefit from the hefty insurance payouts of those patients who will be transferred to more frugal plans.
Currently the state reimburses the doctors for those patients so handsomely that places like the Pasco County Health Department used the revenue to care for other patients who are uninsured.
Dr. Marc Yacht, the director of Pasco's Health Department, said the move would most likely force him to close his sick-care unit unless the state makes other funding available. It would create a hole in the safety net of health services for the poor, he said.
"He's right, it does," Ruggles said.
But the money is needed, Ruggles said, to fight a growing Medicaid deficit. And it was never directly intended to fund uninsured patients anyway.
Struggling families like the Millers of Port Richey, who live off Daniel Miller's $1,500 a month job as a gas station attendant, can qualify for health care at the department either by being the family of a Medicaid-covered patient or by earning less than the federal poverty level -- $17,050 for a family of four.
For the Millers, their two children, who are covered by Medicaid, are the ticket.
About 200 uninsured patients a month visit Pasco County Health Department for sick care, Yacht said.
The Millers' kids are on MediPass, the managed care program administered by the state that's slated for privatization. It's popular, Ruggles said, because as long as the patients get a referral from their primary care doctor, they aren't limited as to whom they see.
Every time a MediPass patient visits the Health Department or another doctor, the provider gets $105, Yacht said. It also gets $3 a month to manage the patient's care.
For the Health Department, that cash, which totals about $600,000 of the department's $10.5-million annual budget, is the only steady flow of money it gets to pay for other services, Yacht said. The other patients are charged on a sliding scale, but the Health Department often doesn't collect on their bills.
State Rep. Mike Fasano, R.-New Port Richey, the House majority leader, said he first learned of Yacht's concern last week and hasn't studied the proposal, which is in the health and human services committee.
"It's just the governor's proposal," Fasano said. "It's the Legislature that will make the final decision. We will hear the pros and cons as time comes along."
The state Department of Health has constructed scenarios for the Legislature that show the hit on Pasco's Health Department would be less. But Yacht said even those scenarios could cost him enough money that he would have to close sick care.
Essentially, the money from the Miller kids' state-managed insurance pays for much of the care their parents receive.
Without them, Yacht said he very likely would have to close his sick-care clinic. Also at risk would be the clinic's dental and prenatal care, he said.
Even if the private HMOs turned around and contracted the patients back to the Health Department, the payment would be much less, Yacht said.
When the system, which is unique to Florida, was created in 1991 and approved by the federal government, Pasco was one of the first health departments brought into the network, Ruggles said. Part of the reason the state contracted with the health departments was to help supply a steady source of funding. It knew the health departments were seeing a large number of uninsured people.
The state hasn't intentionally overpaid for these patients. In fact, Ruggles won't use the word overpaid. But MediPass spends more freely than private HMOs in order to provide access to more doctors, Ruggles said.
The MediPass patients are not limited to the Health Department for primary care, Ruggles said. There are 99 primary care Pasco doctors that MediPass patients can see.
Though their choices would be limited by privatization, the uninsured people their insurance indirectly helps fund would be the hardest hit, critics said.
Those people would likely turn to the hospitals and could face bills that are 10 to 20 times higher than what the Health Department charges, said Bill Jennings, the administrator at North Bay Hospital.
"While the capacity is probably there for them, it's inappropriate use for emergency rooms," Jennings said.
The Millers couldn't afford those bills, they said.
"We'd have to go without," Sandra Miller said. "That's the only way we could do it."
- Ryan Davis covers higher education and social services in Pasco. He can be reached at (800) 333-7505, ext. 3452, or by e-mail at firstname.lastname@example.org.
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