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:

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? Source: Georgetown survey of BCMA/DCMS memberships. (N=126) 40% have kept half or less of their patient load 11% About half

15 Why might providers be leaving? Reimbursement issues: “Medicaid is still not a financially feasible program from my perspective. The reimbursements do not cover the costs of seeing this group of patients.” Paperwork burdens: “It is terrible – much more paperwork – patients are changed to plans they don’t know and to primary doctors they don’t know.”

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 Were there any cases of Medicaid patients: Many/ Some Just a few/ None Where plan benefit limits impeded your ability to provide needed treatments? (N=108) 53%47% Where plan requirements for prior authorization prevented you from providing needed treatments? (N=111) 49%51%

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