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Health & Science

Pediatricians Praise Settlement In 10-Year Medicaid Fight

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A decade long fight over Medicaid has come to a close. Parents and organizations providing healthcare to kids sued the state, saying Florida’s old Medicaid program wasn’t serving kids. Now, they say, Florida has an opportunity to make the system better. 

The Florida Chapter of the American Academy of Pediatrics says it views one-on-one communication opportunities with state healthcare agencies as the biggest win in a settlement over a decades-long lawsuit over children’s healthcare in Medicaid. Tommy Schechtman heads the academy:

"For 10-plus years we haven’t been able to sit at the table with the state. And now we have that opportunity," he says.

The settlement calls on the state to find ways to increase the number of kids getting preventive care, and give providers a way to earn reimbursement rates near Medicare levels. That’s closer to a market rate. The lawsuit began in 2005. In 2011, the state handed Medicaid over to HMO’s to administer, privatizing the program. The new incarnation is called Medicaid Managed Care.

“Some companies have started with what we call pay for performance, or enhanced payments on metrics, he says. "But it hasn’t been consistent or across the board. And that’s what this settlement will achieve.”    

Florida’s rate for uninsured children remains one of the highest in the nation. There’s been tremendous progress in reducing that rate in recent years. But according to a report from Georgetown university, 378,000 kids don’t have insurance. And Schechtman says about 70 percent of them are currently eligible for Medicaid. It’s this group of kids that’s proving hardest to reach.

“There’s been no statewide effort to do targeted outreach, and the settlement speaks to that, and states it’s now an obligation of the health plans and the state.”

The settlement deal calls on state agencies to find ways to get those kids into the system. Schechtman says while it’s not a panacea—expanding Medicaid to more adults could help. He says if parents get insured, they’re more likely to get their kids coverage too. But the Florida’s legislature continues to reject such an expansion under the Affordable Care Act.