June 22, 2007

TROPICAL STORM

The outlook for Medicaid in Florida is dark

Summer in the Sunshine State is off to a gloomy start. The AIDS Healthcare Foundation (AHF) announced this week that it is suing Florida, claiming that the state's Medicaid plan fails to provide people with HIV/AIDS with essential health care. The California-based AIDS group also revealed that during a meeting with three AHF nurses about Medicaid, State Rep. Alan Hays said that his cousin who died of AIDS was "queer as a three-dollar bill" and "got what he deserved." (Hays denies making such remarks). Last but not least, Florida's Medicaid Reform Act, which HIV/AIDS advocates agree cuts dangerous corners, is gearing up to expand to three more Florida counties on July 1. "The Medicaid situation is tragic. The state legislature is using a vulnerable population as a pawn in the state's budgeting priorities," said Michael Rajner, Ft. Lauderdale-based national secretary of the Campaign to End AIDS.

In 2005, Florida Gov. Jeb Bush signed a bill that facilitated implementation of the Medicaid Reform Act. The legislation allowed Florida to apply for a waiver from the federal government to enact its own pilot plan to insure the 2.1 million Floridians on Medicaid. The aim was to save the state money by fostering competition among private insurance carriers and provider networks, but since September 2006, when Broward and Duval became the Medicaid Reform Act guinea pigs, the results have been ugly.

Whereas people on Medicaid used to have access to the same set of doctors, under the new reforms, doctors are spread out over many plans. As a result, patients are having trouble accessing plans that include all of their doctors. And new, added bureaucracy is causing doctors to opt out of Medicaid altogether.

A study by researchers at Georgetown University found that an astonishing 27 percent of physicians polled who participated in the old Medicaid plan in Broward and Duval counties are declining to provide Medicaid coverage under the new plan. Even worse, physicians who take Medicaid patients are seeing fewer of them and reporting "significant difficulties" in giving them necessary care. "Families and people with disabilities on Medicaid are very concerned about being able to keep their doctors under the reform," said Joan Alker, author of the study and a senior researcher at the Georgetown University Health Policy Institute.

In addition, Donna Stidham, chief of managed care for AHF also said that the AIDS Health Care Association(AHCA), the department in Florida that handles Medicaid, doesn't have a good method in place for listening to grievances. "The agency needs to keep its ears open to listen to providers and listen to patients," she said.

"Campaign to End AIDS-Florida plans to continue monitoring the progress of the Medicaid Reform Act and working with other organizations to ensure that the Florida State Legislature places a higher priority on the needs of the have-nots," said Rajner.

AHF filed suit against Florida in federal court this week, alleging that Florida's Medicaid plan fails to provide people with HIV/AIDS who are enrolled in Medicaid with essential medical services as required by Title XIX of the Social Security Act. AHF called for Gov. Charlie Crist to step in to block the expansion of Medicaid Reform.

A spokesperson for the Florida's Agency for Healthcare Administration (AHCA) would not comment on the suit, but said "Our utmost priority is that patients get the utmost services available."

AHF is also lobbying to regain its $4 million Medicaid contract, which was awarded to the for-profit firm Specialty Disease Management Services. AHF has had the contract for eight years under which they serve 8,000 patients. The $4 million contract accounts for only a small piece of AHF's $130 million budget nationwide, but is a nice chunk of its $48 million Florida operations. "This lawsuit is not about who's providing care. The lawsuit is about the fact the care is not being provided," Tom Myers, AHF's general counsel said in a press release. "People are experiencing much less in terms of access to and quality of care. When you have HIV, if you don't get proper treatment you die."

Representatives for AHF were in Tallahassee in mid-June, fighting to hold on to their state contracts. What started out as a polite chat with Republican state representative Alan Hays about why AHF shouldn't lose the contract left the AHF delegation flabbergasted. According to Ron Haberle, a regional manager with AHF, the group was discussing HIV/AIDS when Hays mentioned that he had a cousin who died of AIDS who was "queer as a three-dollar bill" and "got what he deserved."

"Hays seemed very sympathetic at first. It seemed like since we were on the subject of HIV/AIDS, he just kind of made the comment within conversation. It was rather shocking," Haberle said. "Name-calling has been around many years, but to say someone deserves to have AIDS is appalling." Haberle, who is openly gay, said he reminded Hays that AIDS wasn't an exclusively gay disease. Hays acknowledged that and the conversation moved on from there.

Hays' office declined to speak to The Update. In a press release Hays denied making the comments but acknowledged that he did have a cousin who died of AIDS. "I am known for being plain-spoken and for speaking my mind, but I am outraged that this group is making these claims against me," Hays said in the release. This is not the first time Hays has been accused of making a homophobic remark. In March when LGBT high school students were lobbying lawmakers to support adding sexuality to antibullying legislation, several teens said Hays told them gays need psychological treatment.

Regarding the most recent allegations, "It's their word against his," said AHF's Stidham. "But you have three nurses and one politician. And I saw the nurses just minutes after it happened to them. They were shaking like leaves."

AHF is calling for Hays' resignation. "He really should resign, or at the least not be allowed to be on any committees making decisions affecting people who are disabled or HIV," Stidham said.

The Housing Works AIDS Issues Update is reported, written and edited by Diana Scholl, David Thorpe, Phil Fox Rose, Christine Campbell, terri smith-caronia and Housing Works staff. Send your feedback, leads and story ideas to d.scholl@housingworks.org.

You can reach us by phone at 212-967-1500 x168, by fax at 212-868-4222, and by email at d.scholl@housingworks.org. Housing Works provides housing, advocacy and services to homeless people living with AIDS and HIV. Housing Works is the nation's largest community-based AIDS organization and the nation's largest minority-controlled AIDS organization.

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