Title: Florida Center for Medicaid and the Uninsured newsletter
Full Citation
Permanent Link: http://ufdc.ufl.edu/UF00091099/00002
 Material Information
Title: Florida Center for Medicaid and the Uninsured newsletter
Series Title: Florida Center for Medicaid and the Uninsured newsletter
Physical Description: Serial
Language: English
Creator: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Publisher: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: August 2006
 Record Information
Bibliographic ID: UF00091099
Volume ID: VID00002
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.


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Florida Center fr Medicaid and the Uninsured

a Unique Opportunity to Establish Evidence-Based Health Policy to Address Uninsurance

The Florida Health Insurance Study was
first initiated almost 10 years ago. In
1997, the Florida Legislature issued a
budget request assigning the Agency for
Health Care Administration (AHCA)
the responsibility to manage a
comprehensive study intended to
address the problem of uninsurance in
Florida. AHCA contracted with a group
of researchers at UF' to conduct the
1999 FHIS study.
The initial project has evolved into a
multi-year, multi-project series of
studies directed toward specific
elements of access, affordability and
health insurance issues in Florida. After
successful completion of the 1999
study, follow-up research in 2000 and
an additional survey in Miami-Dade
County (2003), funding became
available through the State Planning
Grant program from the Health
Resources and Services Administration
(HRSA) to support the creation of the
2004 FHIS Study. Using 1999 findings
as a baseline, researchers have been able
to measure and better understand
numerous changes in the health
insurance circumstances of Floridians.
For example, over the five year period
the number of uninsured people in
Florida rose by 700,000 from 2.1 to 2.8
million. Such evidence has proved
valuable in the development of state
policy. During the 2004 legislative
session several initiatives were enacted
that addressed uninsurance in Florida.2

1 Department of Health Services Research, Man-
agement and Policy (HSRMP).
2 Pooled purchasing arrangements for small busi-
nesses (25 or fewer employees); possibility of re-
opening the state-sponsored "high risk" pool to
provide health insurance to hard-to-insure persons;
Florida's KidCare Program changes.

Phase II of FHIS 2004 was created to
document and describe Florida's health
care safety-net and its role in providing
care for uninsured people.3 Because
safety-net providers (especially
Community Health Centers and County
Health Departments) have been
identified as critical resources for
uninsured individuals, a primary goal of
Phase II was to assess their ability to
offer and manage limited benefit plans
or other potential coverage options
targeted to the uninsured population.
The assessment was carried out in three
steps: (1) a survey of safety-net
providers to document infrastructure
and capacity; (2) focus groups with
uninsured consumers to document
attitudes, needs, and utilization of health
services; (3) focus groups with safety-
net providers to explore feasibility and
interest in developing and implementing
health insurance programs through
community health clinics.
The survey revealed that although
safety-net clinics regularly accept walk-
ins, patient access is limited by currently
available capacity. If capacity were to
increase, greater access would result.
Focus groups found that the uninsured
are less concerned with health insurance
than they are access to health services.
Some safety net providers expressed a
concern that a new low-cost health
insurance product might actually
increase the number of persons seeking
care without increasing capacity, thus
straining a safety-net that is already
struggling with a high volume of

3 The safety-net is the informal web of providers,
clinics, and programs that offer health services to
uninsured and other low income Americans.

August 2006

Some of our

Medicaid Retartn Eivalua flon
-Researchers from FCMU are collaborat-
ing on a comprehensive, multi-project
study that will evaluate the implementation
of Medicaid Reform and its ability to meet
its stated goals.

"Use of Preventive I-lealth Ser-
vices Atnong Fetwle Medicaid
Beneficiaries with and without
Physical Disabilities -
-The objective of this study is to examine
receipt of preventive health services
among female Medicaid beneficiaries with
and without physical disability. It is hy-
pothesized that, compared to other
women, women with disability would be
1) less likely to receive physical exams
and screening services; and 2) equally
likely to receive vaccinations.

"Depression in Adolescence
-This Medicaid claims-based study will
describe prevalence of adolescent depres-
sion and which medications are being
used to treat depression. Additionally,
these data will be examined from pre- and
post-enactment of a 'black box'warning
(warning on drug that indicates possible
link to suicide).

"Cotnparing the Incidence of Ad-
verse Events Associated with
Drug Treaftnents for
-This retrospective cohort study will
evaluate the safety of central nervous
system stimulants and non stimulants
used for the treatment of ADHD in Florida
Medicaid beneficiaries.

The discussion that ensued centered on
the possible development of a limited
benefit plan, supported by a network of
county health departments and
community health centers. The benefit
package would emphasize preventive
services and could be made available in
the general market, with a low premium
and no subsidy. To learn more visit
fcmu.phhp.ufl.edu and click

Center for Health Care
Racial Disparities Draws
$100,000 in State Funding

The Florida Center for Medicaid and the
Uninsured will become home to a new
research institute focused entirely on
racial disparities in access to and
provision of health care. State
Representative Ed Jennings has worked
closely with UF researchers in
conceptualizing the center's purpose
and mission and successfully secured
funding for its creation in the 2006-2007
state budget.
The Center will be the first of its kind in
Florida and is anticipated to be a strong
base for interdisciplinary research at the
University of Florida and cooperation
among state universities. Research
topics will include disparities in
diabetes, cancer, hypertension, and
overall access to care.

Looking Back:
5th Annual Medicaid
Research Conference

The 5h Annual Medicaid Research Con-
ference was held on June 1-2 at the
Doubletree Hotel in Tallahassee, Flor-
ida. The conference, entitled 'Patient
Empowerment and Health Literacy,'
successfully brought together the fore-
most health services researchers in the
state with policymakers, advocates, and
state agency staff in order to encourage
dialogue between researchers and gov-
ernment officials
The annual meeting was first held in
2001 as an informal research workshop

at the University of Florida with little
over thirty attendees. Each year, the
conference has broadened its scope of
speakers and attendees. This year's con-
ference attracted almost two hundred
attendees from all parts of the state as
well as from Massachusetts, Maryland,
and Washington DC. The conference
drew almost $30,000 in donor support
from around the country. Primary spon-
sorship came from the Nemours Foun-
dation, one of the nation's largest group
practices for children and sponsor of
ongoing research and education pro-
In keeping with the conference theme,
"Patient Empowerment and Health Lit-
eracy," three keynote speakers were
invited to Tallahassee:
Keynote speaker Charles Milligan, of
the Center for Health Program Devel-
opment and Management at the Univer-
sity of Maryland discussed his recently
published Academy Health issue brief
entitled, 1,,i ,,g Medicaid Beneficiar-
ies into Purchasers of Health Care:
Critical Success Factors for Medicaid
Consumer-Directed Health Purchas-

Charles Milligan explains Medicaid Consumer Directed
Health Purchasing to conference attendees 5

Lok Wong, of the National Committee
for Quality Assurance (NCQA) spoke
about Health Care Disparities: Search-
ing for Potential Solutions in Health
Plans and Medical Practices.
Neil Izenberg, founder of Kids-
Health.org, a subsidiary of the Nemours
Foundation, presented his website as a
means to empower patients and families
through free and accessible health edu-


Because of the heightened interest and
attendance, the conference was planned
as a two day meeting with three concur-
rent breakout sessions scheduled for
each day. General topics were: Racial
and Ethnic Health Disparities, Health
Communication and Choice Counseling,
and the Role and Application of Tech-
nology in Health Literacy. For further
information, including access to speaker
presentations, visit fcmu.phhp.ufl.edu.

FCMU Presentations at
AcademyHealth Annual
Meeting, Seattle WA

Three FCMU researchers attended the
2006 AcademyHealth Annual Research
Meeting, June 25-27 in Seattle, Wash-
ington to present research findings from
work conducted at the University of
Florida. AcademyHealth is a profes-
sional society for health services re-
searchers and health policy analysts.
Dr. Allyson Hall gave two talks during
the weekend long conference. The first,
"Medicaid Reform in Florida: Research
Questions," described the basics of the
reform effort and introduced the Medi-
caid Reform Evaluation (MRE) project.
Her discussion focused on challenges
the MRE research team will face in an-
swering key questions about Florida's
health care market and the efficacy of
reform. In her talk, "Predictors of Breast
Cancer Fatalism among Women," Hall
shared findings of a project coauthored
with Drs. Ellen Lopez and Amal
Khoury. The research, also exhibited in
the poster session, found that almost 1
in 3 women strongly agreed or agreed
that breast cancer is a 'death sentence'.
Graduate assistant Cameron Schiller,
MS, presented a project coauthored by
Drs. Robert Weech-Maldonado and
Allyson Hall. The objective of "Patient
Experiences and Utilization in Medicaid
Provider Sponsored Organizations" was
to determine how patient experiences
with care and utilization for three pilot
programs within Medicaid compare to
Medicaid Primary Care Case Manage-
ment (PCCM). Generally, beneficiaries

in the pilot projects appear to have simi-
lar experiences to those in PCCM.
Jingbo Yu, MS, also a graduate assis-
tant, presented a poster exhibit entitled
"Health Insurance Coverage of Young
Adults Aged 22-29 in Florida," based on
data from the Florida Health Insurance

Issues to Watch in
Medicaid: 2005 Deficit
Reduction Act and Proof
of Citizenship

On February 8, 2006, President Bush
signed the Deficit Reduction Act of
2005 (DRA), which is expected to
generate $99 billion in federal
entitlement reductions between 2006
and 2015. The DRA reduces Medicaid
spending at the state and federal level
and changes the way low-income
beneficiaries access health care. Under
DRA, premiums may be introduced,
Medicaid children may be subject to
cost sharing and some adults will have
limited Medicaid benefits.
Beyond spending and benefit cutbacks,
DRA introduces a new federal
requirement, effective July 1, 2006, that
all U.S. citizens and nationals applying
for or renewing Medicaid coverage must
provide documentation of their
citizenship status.
Before DRA, state Medicaid programs
were permitted to request applicants to
provide a written statement to document
citizenship status, under penalty of
perjury. Under DRA, a written
statement will not suffice as proof of
citizenship. Although the Medicaid rules
relating to immigrant eligibility have not
changed, many are worried that the new
policy could present obstacles that make
it more difficult to obtain eligibility for
citizens (i.e.: an African American born
in the rural south who never received a
birth certificate from his home birth).
Some states, such as New York, already
required documentation prior to DRA
and will serve as models to other states
working to adapt to the new regulation.

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August 2006

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