August 18, 2017
Tallahassee, Fla. — Today, CNN ran an article that relied on two year old information which inaccurately characterized Florida’s current CMS Program. The article outlines a screening process that the Florida Department of Health (DOH) has not used in approximately two years – a fact that CNN intentionally buries in their outdated story.
CNN’s reporting demonstrates a misunderstanding of Florida’s Medicaid system, the health insurance industry and the ethical standards of the State of Florida.
A new screening process for CMS Plan clinical eligibility has been in place since January 2016 which was developed by working collaboratively with the CMS medical providers to make sure all children who require the specialized care provided by CMS are eligible for the plan.
Additionally, it is completely inaccurate for CNN to assert that Florida health officials made decisions based on politics. This claim is 100 percent false.
The department remains committed and focused on providing high quality healthcare to Florida’s medically complex children. To ensure the public has the facts regarding CNN’s inaccurate reporting, the Florida Department of Health will set the record straight:
FALSE CLAIM THAT INSURERS BENEFIT FROM SWITCH:
According to the state’s Medicaid agency (Agency for Health Care Administration), it is not true that health insurers benefit from having higher risk patients on their plans. This is a claim CNN makes and then contradicts with the fact that sick children are costlier for insurance companies because of the care they need. There was no financial impact or plan profit from any change. Plans do not receive an individual rate for each enrollee, but rather one overall rate for the entire plan.
CNN states that the department declined to say how much it paid the private insurance companies to insure the children when they were switched out of CMS. The fact is that the department has not paid any private insurance company to cover children who were in the CMS plan.
INACCURATE REPORTING ON THE SCREENING TOOL:
While CNN is focused on a screening process that the department has not used in about two years, the department is focused on providing high quality healthcare to Florida’s medically complex children.
Beginning on January 11, 2016, the department resumed clinical eligibility screening using the process defined by Rule 64C-2.002, Florida Administrative Code. The process includes a two-part approach to clinical eligibility screening – a physician-based, auto-eligibility process using diagnostic codes for chronic and serious conditions and a parent-based survey to ensure that all financially eligible children with special health care needs are given the option to enroll in the CMS Plan. At any time, a parent or physician can request that a child be screened or rescreened for the CMS plan – a fact CNN omits from their story.
Additionally, all families with children previously in CMS who remained financially eligible received a letter informing them that they could be rescreened for clinical eligibility at any time.
STRIDES MADE AND LEADERSHIP CHANGES IGNORED:
The department has held several public meetings and provided other opportunities for collaboration with pediatricians, families, advocates and other stakeholders since 2015. We have made great strides through these opportunities to improve the CMS Plan.
Since the time CNN is speaking of, more than two years ago, there have been multiple changes in department and CMS Plan leadership. Two of the renowned pediatricians CNN mentions in their story have led the department’s CMS Plan in the years following 2015. Dr. John Curran served as Deputy Secretary for CMS from April 2016 to July 2017. This July Dr. Jeffrey Brosco took over following Dr. Curran’s retirement. Both Dr. Curran and Dr. Brosco are highly respected leaders in their field.