How many would drop out if they had to pay a Medicaid premium?
Published: Sunday, January 15, 2012 at 3:33 p.m.
Last Modified: Sunday, January 15, 2012 at 3:33 p.m.
Asked if she could afford $30 a month to keep her three children current on the state's insurance for low-income Floridians, Andrea Powers said she was uncertain.
“Sometimes I can, sometimes I can't,” said the Gainesville stay-at-home mom.
An academic exercise from Georgetown University that was released last month suggests that many parents such as Powers can't afford such a payment.
The Jessie Ball DuPont Fund commissioned a study that GU's Health Policy Institute authored. The study found that the $10-per-patient premium that the Florida Legislature put into the Medicaid reform measure last year likely would result in more than 800,000 children — nearly half of the state's current caseload of children — dropped from the Medicaid rolls.
Florida's premium would be the most far-reaching to date because of the charge to everyone regardless of income or age, the report says.
The premiums are part of a larger Medicaid reform proposal the Legislature passed and that Gov. Rick Scott signed last year. It aims chiefly to move the state's nearly 3 million Medicaid recipients into managed care plans run by private companies. The state would pay the private companies a set amount per patient to manage each person's care.
The federal government has to approve the changes -— including the premium requirement — and that decision is pending. Federal officials said they don't have a timeline for approval.
State Rep. Keith Perry, R-Gainesville, said he voted for last year's reform package that included the premiums. He has also proposed another set of reforms for this session that would put Medicaid beneficiaries into more traditional, private plans.
But he's torn on whether they should pay premiums.
“There should be some level of support” from Medicaid recipients, he said, also adding that he wouldn't want to see truly disadvantaged Floridians dropped from Medicaid because they couldn't pay.
The governor's press office laid out a similar position.
“I can tell you he wants to preserve our safety nets for our children and the most vulnerable among us,” said Lane Wright, Scott's spokesman.
Wright declined to address whether premiums should be paid for each Medicaid patient — saying he hadn't had the time to look into the question.
“Governor Scott hasn't had a chance to see the study you mentioned and evaluate its claims, so we can't respond specifically to that,” he said.
But Wright also said reform is necessary to keep Medicaid's growth in check.
“This spending could overrun our budget,” he said.
As the economy has worsened, the number of Medicaid enrollees has grown in recent years as has Medicaid spending.
Between 2006-07 and the current fiscal year, spending on health care for the state's poorest residents — including those in nursing homes — has increased more than 40 percent to $20.3 billion, the study found.
Meanwhile, the Medicaid caseload that the state Department of Children and Families reported for the district including Marion County in November shows a 67 percent increase since 2006. In the district that includes Alachua County, the number of Medicaid enrollees increased 32 percent to 49,254 residents in November.
To qualify for Medicaid, recipients must earn no more than set income levels, which in some cases are well below the federal poverty level.
Figuring how many Florida children would be dropped from Medicaid was done using the historic experience of other states that had instituted similar requirements with other state-sponsored health insurance, said a spokeswoman for the Jesse DuPont Fund, a Jacksonville-based philanthropic group.
“They used a mathematical formula based on what we've seen happen in other places,” said Mary Littlepage, fund spokeswoman.
Bruce Rueben, president of the Florida Hospital Association, said he's not sure how the state would even begin to collect such a premium.
“I don't know that they can kick you out of Medicaid based on any other criteria than income,” he said. “I don't know how they can make that stick.”
Over at the pediatric clinic of the Alachua County Health Department, nurse practitioner Nancy Day said she couldn't imagine some of the families she sees regularly coming up with the premium payments.
“They don't have $3 to get a bus,” she said. “It's going to be hard on families.”