ACTION - Oppose Medicaid Privatization 10/5
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Subject: Opposing Medicaid Privatization - Press Conference Tomorrow 10/5ACTION: People Over Profits PROTEST at WellCare Building, 8735 Henderson Road, Tampa, FL 33634, noon - 12:45 pm, Wednesday 10/5. Details below and http://www.facebook.com/event.php?eid=226669527391701
This Wednesday, 10/5, the Florida Consumer Action Network (FCAN) http://fcan.org/ will join Organize Now http://www.orgnow.org/, Florida CHAIN http://www.floridachain.org/ and the Florida Public Interest Research Group (PIRG) http://www.floridapirg.org/ in opposing Florida’s request to federal Centers for Medicare and Medicaid Services (CMS) to allow them to expand their managed care of Medicare. Florida PIRG will release a report citing WellCare’s fraudulent practices which creates concern over this request by the state. In 2007, the Federal Government raided WellCare's Tampa offices because they defrauded hundreds of millions of taxpayers' dollars.
WellCare engaged in rewarding their workgroups for disenrolling hundreds of neonatal babies and patients who are terminally ill. WellCare also created numerous schemes to defraud the government by minimizing the company’s refund, or payback obligations, and justifying increases to premiums. One way they did this was to create their own reinsurance subsidiary based in the Cayman Islands. Wellcare overpaid their Cayman Island reinsurance company a rate nearly five times higher than it paid other reinsures. By categorizing these payments as “unrelated activities” the company evaded regulations explicitly denying their reimbursement if the costs of self-reinsurance exceeded the cost of comparable commercial reinsurance premiums.
We are planning a press conference to release the PIRG report and to tell Washington to DENY Florida's attempt to privatize our Medicaid system. We will be at the WellCare Building (8735 Henderson Road, Tampa, FL 33634) from noon until about 12:45 pm. Please join us to oppose the practice of profits over people.
Proposed changes to Medicaid Reform pilot from federal CMS and what it means for new experimentGreg Mellowe, Florida CHAIN
July 28, 2011- In June 2010, the State of Florida submitted a request to the federal Centers for Medicare and Medicaid Services (CMS) for an extension of the 5-year "Medicaid Reform" managed care experiment and the "Section 1115 Demonstration Waiver" of Medicaid-related laws that authorized it. The original Medicaid Reform Waiver and the Special Terms and Conditions (STCs) that defined it were approved in 2005, but were set to expire at the end of June 2011. The Medicaid Reform Pilot area consists of 5 of Florida's 67 counties: Broward, Duval, Nassau, Clay and Baker, although it had originally been expected by the authors of the legislation that Reform would expand statewide by 2010. This was before it became clear to many that the experiment was fraught with problems.
Although the State had requested an extension of the Medicaid Reform Waiver with no changes, CMS advised the State that it would be necessary to more thoroughly evaluate the State's performance in Reform and modify the Waiver to fix obsolete or highly problematic terms and conditions. Over the course of the past year, CMS and the State have been negotiating potential revisions.
Last month, CMS granted the State a short-term extension of the original Medicaid Reform experiment after June 2011 while review and negotiations are completed. Although CMS is preparing to approve an extension of the current Reform Waiver, the revised terms and conditions reflect CMS' recognition of a number of the problems that have plagued the experiment since its launch in 2006. Most importantly, that approval will come with clear expectations that the State and its contracted managed care plans must be accountable, and that recipients and their access to care must be protected. Those expectations will not only be relevant to the Reform experiment and participants in the five Pilot counties, but also to the entire future of Medicaid managed care in Florida. In addition, CMS has clearly anticipated several potential scenarios in which failure to comply with key provisions would result in termination of Florida's authority to continue the experiment.
During its 2011 regular session, the Florida Legislature passed HB 7107/7109, which calls for the implementation of an even broader statewide Medicaid managed care experiment. This new experiment, however, is built solidly on the foundation of the Medicaid Reform experiment and includes many of the same failed core components while adding a number of additional troubling and problematic requests. As a result, the issues raised with the Reform Waiver extension will again be front and center in any future review of the new experiment, especially given that many aspects of what is proposed in the legislation conflict with federal law, regulations and policies. http://www.floridachain.org/issues-article.php?cat=3&article=246&imagen=b5fc90cd-62a1-8e4c-6358-4b99663c63a4.jpg
The first two columns in the table below contain reference numbers and key excerpts from CMS' proposed revised terms and conditions for the extension of the current 5-county, limited Reform Waiver. In the third column, that language is contrasted with the language in the terms and conditions from the original Reform Waiver. In the last column, implications of the changes to Reform proposed by CMS for the new statewide Waiver application are discussed.
Organizer, Tampa Bay
Florida Consumer Action Network
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