Aug 16, 2011

Agency For Health Care Administration (AHCA) Interview

I interviewed Secretary of AHCA, Elizabeth Dudek. These are the Questions I asked her.

To start, can you tell everybody about your self- your background, what you do at AHCA?

1. I've been told that Cover Florida is no longer going to be offered to people who need health insurance, however On July 1 2011 the new PCIP (pre-existing condition insurance plan) will be available. Can you explain that program and how someone can get that insurance?

2. Why is Medically Needy Medicaid offered only to people who have children? One of my readers is an adult cancer patient who has exhausted her savings and healthcare policy limits. Since she is not pregnant and does not have children, she was denied for Medicaid.

3. When I Interviewed Holly Benson, we discussed how difficult and time consuming it is to get a provider number. I still have providers complaining that it takes anywhere from 6 months to a year or more to get a provider number. Also, once providers actually get a Medicaid number, they have to sign up with each separate district at The Agency For Persons With Disabilities. As you can imagine, this is a very long process. With today's technology, isn't there a faster/easier way to do this? When I spoke with Holly Benson about this, she said I should present a suggestion, and I do have one. The Florida Department of Education does an online enrollment for teachers, and it's very nice. Their system keeps track of everything that the teacher submits, and provides alerts for steps they need to take to finish their enrollment. At anytime, a teacher can go online and look to see the status of their application. Can this be modeled?

4. Having multiple insurance policies can sometimes be more of a burden than a blessing. Everyone says they won't pay since they are the payer of last resort. Who is the payer of last resort and how does the process of submitting claims work? In which order do insurance companies pay? Private Insurance, Medicare, Other Medicaid Partners, Waiver, and or ACHA.

5. The Miami Herald did a report on Assisted Living Facilities. People were shocked to learn that Assisted Living Facilities only have to be monitored 1x every 2 years. The Miami Herald reported on a lot of abuse, neglect, filth, and even deaths happening in some homes. Will AHCA be visiting homes more frequently after this report was brought to light. It seems like at least 2 or 3 visits a year are necessary, and some should be unannounced.
6. Some items are covered by Medicaid, but since the reimbursement rate is so low, nobody will cover them. I recently tried to help a family get feeding tubes and I knew they were covered by Medicaid. I had to call several companies before anyone would agree to cover them, and they admitted they were talking a loss but wanted to help the family. What can be done to make the reimbursement rate more fair?

7. There seems to be a shortage of providers in some areas. Dental comes to mind. It's almost impossible to find a Medicaid dentist who will provide sedation. What is being done to recruit new providers in critical shortage areas?

8. I understand that AHCA is taking a strong stand on Medicaid Fraud, and I agree we should not be paying for services that are not rendered. However, in some cases, it seems that AHCA can be overly harsh with providers. I agree we should punish the bad guys, but how can we make sure the good guys don't take the fall.

9. How can AHCA help people who have disabilities who are on the waiting list? I understand that Personal Care Assistance and Diapers are now covered for children who receive Medicaid but what more do you think can be done to help.

10. Kids who are on the waiting list whose parents do not meet the income requirements cannot get Medicaid. What else is out there for them if they don't have insurance? Would they qualify for Kid Care or Children's Medical Service and can you tell me about those plans? Do those plans also cover diapers and personal care assistance?

11. I've spoken with Social workers, Support Coordinators, and Hospital Discharge planners who say they often find themselves confused by all the rules involved to get certain Medicaid services. If it's difficult for the professionals to navigate, you can imagine, its next to impossible for somebody without a professional to assistant them to navigate the system. Where can a family member go for answers?

12. What home and community based waivers does Florida offer?

13. How do you get a wheelchair when you have Medicaid?