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Evaluating Florida’s Medicaid Pilots: Early Reactions from Doctors and Patients

Evaluating Florida’s Medicaid Pilots: Early Reactions from Doctors and Patients. Joan Alker Senior Researcher Georgetown Health Policy Institute May 7, 2007. Our study methods for this brief.

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Evaluating Florida’s Medicaid Pilots: Early Reactions from Doctors and Patients

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  1. Evaluating Florida’s Medicaid Pilots: Early Reactions from Doctors and Patients Joan Alker Senior Researcher Georgetown Health Policy Institute May 7, 2007

  2. Our study methods for this brief • Eight focus groups were conducted in Broward and Duval counties in summer 2006 and Jan/Feb 2007 with Medicaid beneficiaries • Survey of practicing physicians conducted through membership of Broward County Medical Association and Duval County Medical Society from Dec 2006-April 2007

  3. Who is being affected by the Medicaid pilots? • Total enrollment as of 3/07 is 165,674 • Broward enrollment is 101,115 • Duval enrollment is 64,559 • Eighty four percent are children and parents • Sixteen percent are people with disabilities receiving SSI but not Medicare

  4. How are beneficiaries reacting to the new system?

  5. The process of choice • Most beneficiaries are aware that changes are happening • Large range of decision-making experiences so far • Some did not remember receiving state’s “Check it Out” mailing and others were not aware that they had to choose a plan. • Of those that had made a choice, about half had called the choice counseling hotline.

  6. What choices do beneficiaries want? • Virtually all want to keep their doctor(s) • Many cited problems doing so • By and large, they are not choosing on differences in benefit plans. Possible exceptions: • Parents who want dental benefit • People with chronic or disabling conditions may be choosing on different plan drug lists

  7. The tools of choice • Telephone Helpline experiences • Positives: Short wait times, pleasant counselors • Negatives: Information on plan drug lists and accurate provider directories not available • Written materials • Significant comprehension problems exist with respect to understanding the state’s comparison chart • Majority weren’t aware that all children are guaranteed the EPSDT benefit across plans

  8. Broward comparison chart Source: http://www.flmedicaidreform.com/english/children/Broward_Child_Eng_April.pdf

  9. How are physicians responding to the new system?

  10. Overview of MD survey findings • Provider participation in Medicaid appears to be declining • Those providers that remain are seeing fewer Medicaid patients • About half of treating providers are reporting greater difficulty providing needed medical care to patients

  11. Profile of respondents • Results based on responses from 186 doctors • 62% from Duval and 38% from Broward • About half were specialists • Two-thirds of responding physicians are Caucasian

  12. Provider participation is declining • Access to providers is a key issue in Medicaid • One of reform’s goals was to improve access • Twenty seven percent of those who previously participated in Medicaid indicated that they do not plan to join any plans • Little evidence of a countervailing trend of “joiners”

  13. What kinds of doctors are leaving Medicaid? Source: Georgetown survey of BCMA/DCMS membership. (N=36)

  14. What proportion of your patients have you kept as a result of reform? 40% have kept half or less of their patient load About half 11% Source: Georgetown survey of BCMA/DCMS memberships. (N=126)

  15. Why might providers be leaving?

  16. MDs’ experience with payment amounts pre- and post-reform Source: Georgetown survey of BCMA/DCMS memberships. (N=99)

  17. MDs’ experience with paperwork for paying claims pre- and post-reform Source: Georgetown survey of BCMA/DCMS memberships. (N=103)

  18. How is access to care being affected? • Possible barriers to care include benefit limits, prior authorization and other plan approval procedures • Over time, it is more likely that benefit limits will affect adults. • Issue of prescription drugs subject of upcoming brief.

  19. Have you noticed changes in your ability to provide medically necessary care to children since reform began? Source: Georgetown survey of BCMA/DCMS membership. (N=67)

  20. About half of treating MDs report difficulties in providing care

  21. Conclusion • Clear warning signs re provider participation and access to medically necessary care • Consumers are confused about choices but clear about what they want • Trusted providers • Prescription drugs • For parents, dental benefit • Complexity of new system is a challenge to both doctors and patients

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