FLORIDA UNITED FOR CHOICE –

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WHY INCLUDING THE DEVELOPMENTALLY DISABLED OF FLORIDA INTO AN HMO MODEL IS NOT GOING TO WORK:

*We are fundamentally opposed to the aspect of Medicaid Reform that entrusts the coordination and care of the developmentally disabled of Florida to Health Maintenance Organizations (HMO’s). The current system of identifying, providing, overseeing, and funding of needed supports and services to the disabled of the state involves thousands of private contract HCBS Medicaid Waiver support and service providers who advocate for the needs of their caseloads and strive to get the needs of the developmentally disabled citizens of the State met. These providers work in concert with the state’s Agency for Persons with

Disabilities (APD) playing a significant role in quality assurance and oversight of the system. Surrendering the entire service system over to contracted HMO’s would eliminate choice, eliminate adequate oversight, and it would create a system nearly impossible for a developmentally disabled citizen and/or their family to navigate. Our reasons for opposing an HMO take over of the support and services system for the developmentally disabled of Florida are:

HMO is Not the Model That Best Serves the Developmentally Disabled Population

*There is something fundamentally different about being developmentally disabled versus any other kind of public assistance recipient — HMO is not geared for them.*

  • · Developmentally disabled (“DD”) recipients had absolutely no choice being born with their conditions and situations. They made no mistakes, errors in judgment and the nature of their assistance is hardly ever temporary.
  • · They will need life long care and support from an established cadre of specialized providers knowledgeable in DD issues. This care involves much more than merely medical concerns.
  • · There are social, self-care and self-advocacy issues that are unique to them. Many are non-verbal and nearly all could not successfully understand and navigate an HMO’s 1-800 number access system nor be able to advocate for their own needs effectively against an HMO’s opposition to funding services. Disabled people are easily intimidated and confused. Frequently they are cared for by highly stressed single caregivers. Yet they are lumped together with non-disabled welfare recipients.
  • · 30,000 people with disabilities and their families including over 2.7 million other voting Floridians will be negatively impacted. HMOs and PPNs are based on a medical model not on the special needs of DD consumers.

 

CHOICE

The thousands of service providers in the current system are hired and fired by the recipients of services THEMSELVES.

  • · In other words, the disabled of Florida now have the greatest choice in the freest fair-market system anywhere in the country. They have an independent case manager–a Support Coordinator whom they can hire and fire–whose overriding responsibility is to advocate for their preferences, help them identify their needs, and then assist them in navigating many complex service systems.
  • · When a disabled recipient is unhappy with the service provider (Support Coordinator, Respite provider, Companion, etc.), they can immediately terminate them and then be assisted in interviewing and locating a replacement provider that will best meet their needs.
  • · Going to an HMO model would eliminate this choice-based fair-market model. It would require them to rely on an HMO-funded case manager—a case manager WITHIN the HMO itself to push for support and service approvals and navigate the HMO’s complex requirements for these service approvals. In other words the HMO-funded case manager would be tasked with advocating against his own employer on behalf of the disabled person. This represents a debilitating conflict of interest as the HMO’s essential concern is profit and that case manager works for them. HMO’s have no established history of dealing effectively with this inherent conflict.
  • · A developmentally disabled recipient would essentially go from a model offering thousands of providers to a small handful. Opting for an HMO take-over of services for the developmentally disabled of Florida removes choice for these citizens and needlessly eliminates the highly specialized providers that these disabled individuals have known for years, come to trust, and who have developed an accurate and effective understanding of them and their needs. *This is a process that takes years with this population and equates in many cases to their avoiding institutionalization. Eliminating the independent provider system in favor of approximately 4 HMO’s carving up the state eliminates the current independent advocate provider system. This represents removing independent third party advocacy for the most vulnerable, poor and disabled population of the state.

Fiscal Responsibility:

It is understood that the state is in difficult financial times and that spending must be reduced.

  • · The developmentally disabled of Florida and their caregivers as well as the provider system that works for them understand the need for a sustainable system. The current Agency for Persons with Disabilities

(APD) and HCBS Medicaid Waiver systems afford the state an effective infrastructure to enforce accountability and compress funding when times are tough.

  • · Rather than paying HMO’s a fully-funded contract UP FRONT for five years, the current system allows the state to enact reductions at any time until the economic situation improves. Simply put, the current system allows the Florida state government real, dynamic flexibility. (*You can tear pages out of the

Waiver Services Handbook but keep the book so that when you can you add those pages BACK IN.)

  • · The current ‘Tier system’ places recipients into capped budgets. This is a ready infrastructure that allows you to decrease budgets for individuals receiving services when you have no other choice because of the economic situation. And again, when the budget improves, you can increase the Tier budgets for recipients.
  • · Once in a contract with an HMO you are stuck with that system for 5 years, regardless of how well or poorly the HMO performs. Historical data throughout the history of HMO’s in this country shows it is extremely difficult and costly to recoup funding from them when improprieties are discovered.

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