This report discusses the monthly meeting of the South Florida AIDS Network (SFAN). SFAN is the advisory board for the Ryan White Care (RWC) program of the Florida Department of Health in Broward.
On March 1, SFAN held an evening community meeting. That meeting discussed problems related to changes in the PAC Medicaid Waiver program.
The PAC Medicaid Waiver Program had allowed Medicaid to pay for services not covered by Medicaid. Eligibility for this program was restricted to clients with specified serious diseases like HIV. Case managers at RWC agencies could authorize those services.
The Agency for Health Care Administration (ACHA) manages Medicaid in Florida. Its auditors discovered irregularities in the program. Some case managers had authorized expenses that they should not have authorized. ACHA then launched a statewide investigation.
ACHA has moved the case manager role from RWC agencies to agencies that specialize in case management. In many Florida counties, this transition has occurred with minimal disruption. In Broward, clients have reported problems.
Joey Wynn, SFAN chair, said that this meeting would collect reports of these problems. He stressed that this meeting would only gather and document problems. SFAN would then bring these documented problems to ACHA and demand accountability. SFAN would present the results of that meeting at the April meeting of SFAN.
Wynn said that some Medicaid clients with HIV need intensive case management to avoid hospitalization. Effective case management can contain costs without decreasing available services.
ACHA has designated two agencies as enhanced HIV agencies: Clear Health Alliance and AIDS Healthcare Foundation. These agencies provide special HIV training to their staff. In return, these agencies can charge ACHA an “enhanced rate.” In addition, three Medicaid managed care companies provide telephone-based case management: Amerigroup, Clear Health, and Positive Health Care.
Gary Hensley of SunServe said that these case management agencies have failed to link with the prior case managers. SunServe had previously provided these case management services.
About six Broward Medicaid clients reported problems. These clients reported that the contact numbers for Amerigroup and Clear Health had Miami-Date area codes. Providers that served both counties reported that Miami clients did not have problems. Only Broward clients had problems.
Clients reported many issues. Some case managers referred clients to doctors that did not accept their insurance. Some case managers failed to return phone calls about serious medical issues. Some case managers had failed to contact their clients for three months or more. Some case managers and their supervisors lacked basic knowledge about HIV and failed to understand HIV terminology. Their clients had to educate them. Case managers used to help clients reapply for Medicaid. Now some were refusing to do so.
A black male client broke down in tears while telling his story. In addition to HIV, he has balance issues. He has fallen. He had to lean on a cane to speak. He appeared to be having some speech issues and to be short of breath. He said that he had seen his case manager once and that lasted just 40 minutes.
Wynn stressed, “People are getting paid to perform a service. If they are not providing that service, they should lose that contract and give the contract to someone who can.”
SFAN and Broward Department of Health are conducting an online survey to learn about perceived availability of services for people not living with HIV. The survey will be available through April 13, 2018. It is available online in English and Spanish (https://www.surveymonkey.com/r/jwky2xg), and Kreyol (https://www.surveymonkey.com/r/dzzz7rf).
The next SFAN Meeting will be on Friday, April 6, 2018 at 10:00 a.m., at the Holy Cross Healthplex, 1000 NE 56th Street, Ft. Lauderdale.