Medically Needy Waiver Your comments are needed now!

This week board chair Stan Whittaker attended a public hearing on another proposed waiver to Florida's Medicaid program. This program will move all "Medically Needy" individuals into the Managed Care program that is also under consideration for a waiver.

The Medically Needy (also called Share of Cost) program is the component of Medicaid that provides short-term coverage to patients who are over the income limit for regular Medicaid but have catastrophic medical expenses and are otherwise Medicaid-eligible. Under the Medically Needy program today, once a patient's total medical bills for the month "paid or unpaid - add up to an amount that approaches monthly family income, Medicaid coverage kicks in for the rest of that month. (That process is known as meeting Share of Cost for the month.) Among those who must rely on the program on an ongoing basis are dialysis patients, organ transplant recipients, and children with complex medical needs. (Press release FLCHAIN Oct 18,2012)

Patient Access to Nurse Practitioners will be reduced with the New Waiver.  Medically needy patients are especially vulnerable. Presently a Nurse Practitioner may be directly empanelled and reimbursed under the Medicaid-fee-for-service program. However according to AHCA this practice will have to stop because of the state's restrictive Nurse Practice Act. Under the new waiver, and because of the state's restrictive Nurse Practice Act, Nurse Practitioners will no longer be able to directly empanelled as providers with HMOs. Instead, they will have to be empanelled as a provider under the license of a physician contracted with the particular HMO plan. Similarly, Nurse Practitioners will no longer be directly reimbursed for their services and instead payment will go to the physician.  This policy will limit access to care for patients by making it harder for Nurse Practitioners to provide care and stay in business. Many Nurse Practitioners have expressed concern that they will have to close their clinics because of this policy. The waiver should be denied until access to full scope Nurse Practitioner care can be guaranteed.