August 28, 2007 Surprise Bush Administration Guidelines Sharply Curtail States' SCHIP Expansions In a surprise move, the Bush administration has notified state governments of new federal guidelines that children’s advocates fear will render moot the substance of State Child Health Insurance Program (SCHIP) reauthorization bills. The new rules would severely limit the ability of states to set their own eligibility guidelines. These rules may provide a chilling effect on efforts by children’s advocates to streamline and ease accessibility to the KidCare program, currently covering less than half of this state’s 550,000 eligible children. (by Andrew Leone, Florida CHAIN) Read more Photos, L-R: 1.  Families sign up for Florida KidCare at the St. Petersburg enrollment fair. 2.  St. Petersburg City Council member James Bennett presents Florida Covering Kids & Families' Coordinator Patrick Cannon with a city proclamation. 3.  Kids in Marianna, FL enjoy new backpacks provided by Office Depot at the Panhandle Area Health Network news conference & enrollment fair. 4.  Children enjoy many Florida KidCare giveaways at Harvest Time Int'l.
Florida Covering Kids & Families Holds Back-to-School News Conferences and Enrollment Fairs Across State This summer, Governor Crist initiated a Back-to-School outreach campaign to raise awareness of low-cost or free health coverage to children through Florida KidCare. This effort included news conferences and enrollment fairs. Elected officials, pediatricians, and parents spoke about the importance of children's health coverage while local projects and staff from several Florida departments enrolled families in KidCare. Each event included presentations of local government proclamations in support of providing children with health insurance. Hundreds of backpacks provided by Office Depot and back-to-school supplies donated by health plans were distributed to applicant families. (by Patrick Cannon, Florida Covering Kids & Families) Read more Tell the President & Congress Before It’s Too Late! Sign SEIU's Petition to Reauthorize SCHIP Make sure you sign the Service Employees International Union (SEIU) petition. Then, please send it to your friends, colleagues, and family. (thanks to Families USA for this alert) Read more & TAKE ACTION!
"Florida Trend" Article on Medicaid Reform The Medicaid Reform implementation in Broward and Duval counties, and its expansion to rural Clay, Baker and Nassau, is helping outline different perspectives on the broader questions of future health care in Florida and nationwide.  By focusing on delivery of care for Medicaid beneficiaries, participants on all sides believe they have everyone's broader interests at heart. On one hand are state administrators entrusted with taxpayers' resources that are finite and often insufficient to deliver the services they are asked to deliver. On the other hand are consumers and their advocates trying to shift the debate toward delivery of services that consider individuals first, not data to be calculated in percentages. An article by Barbara Miracle in the September issue of "Florida Trend" Magazine, "Medicaid Progress Report," goes to some lengths to show this. (by Andrew Leone, Florida CHAIN) Read more & link to the "Florida Trend" article Medicaid Reform Roundup   Technical Advisory Panel (TAP) Meeting The Medicaid Reform Technical Advisory Panel met August 20. Issues of particular interest to consumer advocates included updates on the Enhanced Benefits program, the Choice Counseling component, and a report on the expansion into Clay, Baker and Nassau Counties. No consumer representatives have been integrated into the TAPan issue Florida CHAIN and others have repeatedly pointed out over the past year.   Effect of Property Tax Cuts Meanwhile, following the concerns raised by the Nassau County Commissioners on the effects of Property Tax cuts on their ability to deliver services to the needy in the midst of Reform, the tax cuts’ effects on Duval have also become apparent through proposed municipal cuts.   Orlando Medicaid Reform/Health Access Forum on August 30 Hispanic Health Initiatives will sponsor a town hall meeting in Orlando to discuss health care access and the effects of Medicaid Reform in the pilot counties. The town hall meeting will be held on Thursday, August 30, at the Englewood Neighborhood Center, 6123 La Costa Drive, Orlando beginning at 6:00 pm. Light refreshments will be provided and admission is free.   (by Andrew Leone, Florida CHAIN) Read more about these three topics Access to Care Made Difficult for Children   With new questions raised by the federal government about Florida's Medicaid Reform project, policy-makers need to examine its effect on children with long-term, complex medical needs. Reform has made it difficult for parents to access essential services, including: specialist care; therapies, in-home nursing and day treatment centers that prevent costly hospital re-admissions; post-hospital care; and transportation. Until policymakers correct the fragmentation and frustration created by Reform, they should not expand it. Families face significant challenges in raising a medically fragile child. We should not allow Medicaid reform to further complicate their lives.  (by Alisa Snow, Alliance of Florida Prescribed Pediatric Extended Care, published Aug. 3 by South Florida Sun-Sentinel) Read the op-ed & a published response by Jacqueline Philippoussi, Carmen Pediatric Care Center Study Questions Medicaid Managed Care Services Delivery to Pregnant Women   Findings from a new study on managed care’s impact on pregnant enrollees offer a cautionary tale for Florida policymakers as they evaluate Medicaid reform and consider expanding it beyond five pilot counties. According to the report, Medicaid managed care reduced access to prenatal care and increased poor birth outcomes among participants in California during a county by county roll-out of a state health care reform plan. Given California’s experience, the impact of Medicaid managed care on pregnant women should be carefully examined before Florida's reform efforts are expanded statewide. (by Carol Brady, Northeast Florida Healthy Start Coalition) Read more & link to the study
Health Care Budget Reductions Priority Areas Pose Significant Impact for Low-Income Floridians AHCA has identified 24 priority areas for budget reductions to meet the state's 10% "savings" exercise. Florida legislators, now in committee meetings, will convene in Special Session on September 18 to balance the budget by cutting $1.2 billion. AHCA's proposed cuts include eliminating the Senior Care managed care pilot and the MEDS-AD Waiver (that would impact persons 65 and older or disabled with an income up to 88% of the federal poverty level), hospital and nursing home reductions, and restricting the medically needy program to children and pregnant women. AHCA notes that this "will have a significant impact on the ability of individuals with low incomes to access critical health care." (by LuMarie Polivka-West, Florida Health Care Association)  Read more Medicaid Medically Needy Share of Cost Program on the State’s “Chopping Block” Again   The Medically Needy Share of Cost Program, covering medications and health care needs for thousands of low-income Floridians whose monthly income puts them over the Medicaid eligibility threshold, could suffer severe cuts as the legislature looks to address a $1.2 billion budget shortfall in special session.  Consumers and their advocates have pointed out that most Medically Needy have prescription and health care costs that already far exceed their ability to pay for them. These Floridians are often transplant survivors, patients with HIV or AIDS receiving Social Security Disability Income, or people who have suffered another catastrophic illness or injury. (by Bill Rettinger, MedicaidAdvocates.Com)  Read more “Don’t Cut Mental Health Programs,” Say Experts   As Florida legislators prepare to cut $1 billion from the state budget passed just three months ago, leaders from the mental health community are pleading to be spared cuts that could have a major impact on schools, workplaces and communities. Mental health and substance abuse experts fear program cuts of as much as $50-60 million, cuts they say Florida can ill afford - disastrous for individuals and their communities, while increasing, for years to come, costs for hospital inpatient services, emergency-room care, shelters, foster care, juvenile detention facilities, jails and prisons. (by Florida Council for Community Mental Health)  Read more
Attention: Individuals and Families Affected by Waiver Service Reductions Letters were mailed to individuals and families from the Agency for Persons with Disabilities (APD) in June notifying 4,000 individuals of their service limitations that were established as law and will became effective on August 1. Letters were also mailed to individuals and families advising them of pending service eliminations in June. If you have had services reduced and/or will experience service eliminations, share your situation for research and advocacy. (distributed by Florida Developmental Disabilities Council)  Read more
REAL STORIES FROM FLORIDA HEALTH CARE CONSUMERS Letters to Florida Medicaid Director Confirm Reform Consumers' Difficulties Must Be Evaluated Before Expansion    At the start of the 2007 legislative session, Mr. Tom Arnold, Director of Medicaid, reported to the Senate Health Policy Committee that his office at that time “had not received more than 10 complaints about Medicaid Reform." In an effort to keep Mr. Arnold informed of issues being raised by consumers, Florida Legal Services, Florida CHAIN and other organizations comprising the Medicaid Reform Advocates Coalition (MRAC), have produced and forwarded to Mr. Arnold letters documenting these on a regular basis. We intend to continue submitting them as long as necessary, to point out that Medicaid Reform needs to be evaluated from the perspective of how it affects individual consumers before it is considered for expansion statewide. Read the most recent letter to Director Arnold, including nine case stories illustrating a number of serious difficulties experienced by people as a result of Medicaid Reform.
Health Care for All–Florida Informed on Models, and Develops Strategies Working to gain momentum on issues related to universal health care while expanding its activist base, Health Care for All-Florida recently held an informational meeting in Coral Gables. The event included a presentation on the Italian system of universal coverage, ranked second internationally by the World Health Organization. The group then discussed strategies for legislative and media actions. These include targeting specific Florida elected officials as part of a national call-in day of support for HR 676, the “Medicare for All” bill, on September 6. (by Andrew Leone, Florida CHAIN) Read more Florida CHAIN Awarded Grant from Health Foundation of South Florida to Expand Medicaid Reform Evaluation   Florida CHAIN has announced receipt of a $50,000 grant from Health Foundation of South Florida to support efforts at including the voice of Medicaid Reform consumers in evaluation of the program. The grant will allow for development of forums allowing consumers to communicate to legislators in Broward and Miami-Dade counties their experience with Medicaid Reform for the purpose of reining-in its expansion beyond the pilot counties. In addition, the grant will provide consumers with the opportunity to offer input on alternative solutions to Medicaid Reform. (by Andrew Leone, Florida CHAIN) Read more
CHAIN Reaction is a bi-weekly publication of Florida CHAIN (Community Health Action Information Network), a statewide consumer advocacy organization that works toward access to quality health care, empowering people to actively shape their world by participating in civic life and caring for each other’s well being.  Florida CHAIN: 6600 Cypress Road #508, Plantation, FL 33317   info@floridachain.org     www.floridachain.org
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Florida Covering Kids & Families Holds Back-to-School News Conferences and Enrollment Fairs Across State

This summer, Governor Charlie Crist initiated a Back-to-School outreach campaign to raise awareness of the availability of low-cost or free health coverage to children through Florida KidCare. To conduct this campaign, the Agency for Health Care Administration (AHCA) asked Florida Covering Kids and Families of the University of South Florida’s Lawton and Rhea Chiles Center for Healthy Mothers and Babies to coordinate the outreach campaign and provide technical assistance to targeted areas across the state. The initiative was developed in collaboration with the Governor’s office and the Florida Department of Health (DOH), including Children’s Medical Services (CMS), the Department of Children and Families (DCF), and Florida Healthy Kids Corporation. 

Kids in Marianna, FL enjoy new backpacks

provided by Office Depot at Panhandle Area

Health Network news conference/enrollment fair

A major thrust of this effort included news conferences and enrollment fairs that took place during early August in four parts of the state: the Panhandle, Heartlands, Pinellas County, and Orange-Seminole counties. The Panhandle event was sponsored by the Panhandle Area Health Network, Pinellas County’s event was organized by Healthy Start of Pinellas, Inc., the Orange-Seminole event was put on by Harvest Time International, and Central Florida Health Care, Inc., hosted the Heartlands event. 

All the events were tremendously successful. Elected officials, pediatricians, and Florida KidCare parents spoke about the importance of health coverage for children while local projects and staff from AHCA, DCF, county health departments, CMS, and the Department of Revenue enrolled families in Florida KidCare. Each event included presentations of proclamations passed by local governments in support of providing children with health insurance. Hundreds of backpacks provided by Office Depot and back-to-school supplies donated by health plans were distributed to families applying for KidCare. Media coverage of the events was extensive, including TV, radio, and print. 

The news conferences and enrollment fairs were part of Florida Covering Kids and Families’ statewide outreach effort that includes forming partnerships with businesses (such as Wal-Mart, Walgreens, Sweetbay, Albertsons, and Radio Disney) and working to build sustainable coordinated outreach efforts throughout Florida. 

(Submitted by Patrick Cannon, Ph.D., Coordinator,

Florida Covering Kids & Families Initiative)

Access to care made difficult for children

August 3, 2007
By Alisa Snow

With new questions raised by the federal government about Florida's Medicaid Reform project, policy-makers need to examine its effect on the most vulnerable patients: children with long-term, complex medical needs.

In January, the state required "children with chronic conditions" to enroll in Medicaid reform health care plans in Broward County. Children in this Medicaid category have birth defects such as cerebral palsy or cardiac abnormalities. Some children were born prematurely and many suffer from chronic respiratory problems.

Florida Medicaid officials recognize that these children benefit from certain therapies, in-home nursing and day treatment centers, and they can prevent costly hospital re-admissions.

But Medicaid reform health plans don't offer many of these services. Parents have significant problems locating pediatric cardiologists and other specialists in their child's health plan network. Once they locate one, parents have even more difficulty getting a timely appointment.

We know of one pediatrician who re-admitted his patient to the hospital so the child could get treated by a specialist. This is hardly a model for cost savings.

Medicaid reform has made it difficult for families to access post-hospital care for their children.

Take for example Prescribed Pediatric Extended Care centers, which are non-residential treatment facilities that provide up to 12 hours of daily nursing care. In the past, a medically complex child could get transportation to the PPEC, medical care and therapies under one roof.

This is no longer the case under Medicaid reform.

First, we find that some plans deny PPEC services to children if the child's mother doesn't work. Apparently, the health plan service authorization teams believe that if the mother is at home, she can provide the 24-hour, seven-day-a-week medical attention herself. This forces families to enroll their children in home health nursing services, which according to Medicaid, is less cost effective than PPECs.

Second, we find that health plans limit the number of respiratory, occupational, speech and physical therapists in their network. If a PPEC therapist is not on the child's health plan, we cannot provide that service in our facility. Parents have to take their child elsewhere for therapy.

Third, transportation has become a logistical nightmare. In the past, one Medicaid transportation company took children to and from the PPEC. Under Medicaid reform, each health plan hires its own transportation contractor, which means multiple companies transport the same number of children that could have been transported by one vehicle. What's worse, PPECs have to provide additional nurses and medical escorts to ride with children. Again, where are the cost savings?

Transportation guidelines are inconsistent under Medicaid reform, and some providers are unfamiliar with the needs of these children. One PPEC witnessed a transportation company driver attempt to secure a child's wheelchair with a rope, instead of a wheelchair strap as required under ADA regulations. This is not acceptable.

Finally, providers who care for chronically ill children often wait months before they get reimbursed by one particular provider service network. Part of the problem is the state allowed this health plan to go into effect without full electronic billing procedures in place. We are told that provider service networks don't have to follow the same "prompt payment" law that HMOs have to follow when paying health care providers.

The state Medicaid office, its fiscal agent and the health plans continue to work out technical problems with the billing process. To their credit, state Medicaid officials hold routine conference calls to fix these problems. But help hasn't come soon enough for two PPEC providers in Broward County who recently had to secure $525,000 in loans just to make their payroll.

Overhauling the Florida Medicaid program is no easy task, which is why the Florida Legislature limited this reform experiment to five counties through the end of this year. Until policymakers correct the fragmentation and frustration created by Medicaid reform, they should not expand it to other counties.

Families face significant challenges in raising a medically fragile child. We should not allow Medicaid reform to further complicate their lives.

Alisa Snow is director of the Alliance of Florida Prescribed Pediatric Extended Care. 

Copyright © 2007, South Florida Sun-Sentinel

Copyright © 2007, South Florida Sun-Sentinel

Study Questions Medicaid Managed Care Services Delivery to Pregnant Women

Findings from a new study on managed care’s impact on pregnant enrollees offer a cautionary tale for Florida policymakers as they evaluate Medicaid reform and consider expanding it beyond five pilot counties.

According to the report, Medicaid managed care reduced access to prenatal care and increased poor birth outcomes among participants in California during a county by county roll-out of a state health care reform plan.

Using a longitudinal database, researchers examined the impact of switching from a fee-for-service system to managed care for individual mothers. Early initiation of prenatal care dropped by 4 to 8 percent following enrollment in a managed care plan. Even more disturbing was the impact on birth outcomes—the incidence of low birthweight, prematurity and neonatal death all increased among Medi-Cal women following the introduction of Medicaid managed care.

Researchers found “strong evidence that health care providers responded to managed care incentives to reduce costs by limiting care and ... that these limitations in care had negative effects on infant health.”

Like Medicaid reform efforts in Florida, California’s plan excluded higher income women who receive Medicaid benefits only during pregnancy. During its pilot phase, Florida’s Medicaid reform program allows other pregnant women to voluntarily participate in a managed care plan.

Changes in access to and use of prenatal care, as well as local systems of services, could erode Florida’s progress in addressing the health of vulnerable women and children. Improvements in infant mortality, experienced by the state over the last decade, have stalled in recent years. Given California’s experience, the impact of Medicaid managed care on pregnant women should be carefully examined before reform efforts are expanded statewide.

(Submitted by Carol Brady, Executive Director,

Northeast Florida Healthy Start Coalition, Inc.)

“Don’t cut mental health programs,” say experts

As Florida legislators prepare to cut $1 billion from the state budget passed just three months ago, leaders from the mental health community are pleading to be spared cuts that could have a major impact on schools, workplaces and communities.

Mental health and substance abuse experts fear program cuts of as much as $50-60 million when the Legislature meets in special session on Sept. 18.  And, they say, those are cuts Florida can ill afford.

"Cutting back on funding for the essential services that community mental health programs provide would be disastrous for the individuals who so desperately need help and the communities in which they live," said Maggie Labarta, chairman of the Florida Council for Community Mental Health and CEO of Meridian Behavioral Healthcare in Gainesville.

According to Labarta, not funding mental health services now will have a serious impact for years to come as costs increase for hospital inpatient services, emergency-room care, shelters, foster care, juvenile detention facilities, jails and prisons.  "Cutting these programs today will cost us exponentially more in the future," said Labarta.

Gary Bembry, chair of the Florida Council for Community Mental Health and CEO of the Lakeview Center in Pensacola, agrees.  Bembry believes that cutting funding for mental health programs will create serious problems in Florida's corrections system.

"Our lack of success in keeping ex-offenders from re-entering the corrections system costs Florida taxpayers millions each year," said Bembry.  "With 20 percent of the 10,000 ex-offenders released every year having a significant mental illness, we are paying $120 million annually for their reentry into the prison system.  Investing in community-based mental health programs that can provide transitional centers and support staff is the key to tracking, counseling and guiding ex-offenders with mental illnesses toward safe and healthy actions and away from our prison gates."

Cutting mental health programs which help young people is even more troubling, says Veronica Valentine, chairman of the Florida Council for Behavioral Healthcare and CEO of the Child Guidance Center in Jacksonville.

"It is estimated that 600,000 Florida students have an emotional disturbance encompassing a range of conditions and diagnoses, including schizophrenia, bipolar disorder, depressive or anxiety disorders, attention deficit hyperactivity disorders and impulse control disorders." said Valentine.  "And, nearly three-fourths of those students are not receiving the health or behavioral health services they need, either from school or community agencies, resulting in them struggling academically and socially, getting in more trouble and continuing their emotional spiral downward."

"Florida is dealing with a mental health crisis and now is a critical time to ensure funding for community-based services for those who need it most," said Bob Sharpe, president of the Florida Council for Community Mental Health.  "We want to be sure our state's leaders understand that Florida is at a crossroads and what we do now for some of our most vulnerable citizens will have a dramatic effect on our families and communities well into the future."

According to Sharpe, Florida ranks 48th in the country in per-capita spending for mental health services and 35th in the nation in per-capita spending for substance abuse treatment.  The state ranks 37th in Medicaid per-capita spending for enrolled disabled beneficiaries and 47th in Medicaid per-capita spending for enrolled children.  At the same the same time, Florida ranks second in the number of homeless, first in the number of substantiated reports of child abuse and neglect, second in the number of children in juvenile detention facilities and third in the number of prison inmates.

A significant portion of these problems can be traced directly to the lack of mental health care, says Sharpe, who also believes that funding the mental health system can result in a significant return on investment.

"Mental health services should be treated as essential – like fire and police services.  Proper mental health treatment and care can allow people with mental illnesses to live healthy, productive lives.  Individuals without the proper treatment are more likely to be underemployed or unemployed, at risk for homelessness or enter into a cycle of last resort care in high-cost settings such as institutions or jails."

The Florida Council for Community Mental Health is joining forces with the Florida Council for Behavioral Healthcare, the Florida Alcohol and Drug Abuse Association, the National Alliance on Mental Illness-Florida and other organizations in urging the Florida Legislature to minimize budget cuts to community mental health and substance abuse programs.

(submitted by Florida Council for Community Mental Health)

 

---

Attention: Individuals and Families Affected by Waiver Service Reductions

Letters were mailed to individuals and families from the Agency for Persons with Disabilities (APD) in June notifying 4,000 individuals of their service limitations that were established as law and will became effective on August 1, 2007.

Letters were also mailed to individuals and families advising them of pending service eliminations in June. These letters did not contain an effective date, but requested that individuals contact their support coordinator to initiate planning while approval for service's elimination is being obtained from Washington, D.C.

If you have had services reduced and/or will experience service eliminations and are willing to share your situation with the Florida Developmental Disabilities Council, Inc. for research and advocacy efforts - please contact Waiver Reduction Alert: call 850/488-4180 or email vandab@fddc.org

(distributed by Florida Developmental Disabilities Council, Inc.)

REAL STORIES FROM FLORIDA HEALTH CARE CONSUMERS

Letters to Florida Medicaid Director Confirm Reform Consumers' Difficulties Must Be Evaluated Before Expansion 

At the start of the 2007 legislative session, Mr. Tom Arnold, Director of Medicaid, reported to the Senate Health Policy Committee that his office at that time “had not received more than 10 complaints about Medicaid Reform.  In an effort to keep Mr. Arnold informed of issues being raised by consumers through town hall meetings, roundtable discussions and interviews, Florida Legal Services, Florida CHAIN and other organizations comprising the Medicaid Reform Advocates Coalition (MRAC), have produced and forwarded to Mr. Arnold letters documenting these on a regular basis.

Below is the most recent.  We intend to continue submitting them as long as necessary, to point out that Medicaid Reform needs to be evaluated from the perspective of how it affects individual consumers before it is considered for expansion statewide. Any reader who wishes to share an experience related to Medicaid Reform, or who knows of someone with a relevant situation, is welcome to contact Andrew Leone at andrewl@floridachain.org

FLORIDA LEGAL SERVICES, INC.
MIAMI ADVOCACY OFFICE
3000 Biscayne Boulevard, Suite 450
Miami, Florida 33137
Telephone: 305-573-0092 ext. 206
Fax: 305-576-9664

KENT R. SPUHLER, DIRECTOR
ATTORNEYS:
VALORY GREENFIELD
MIRIAM HARMATZ  
ARTHUR J. ROSENBERG
CHARLES F. ELSESSER

August 25, 2007

Tom Arnold, Director

Florida Medicaid Program

Agency for Health Care Administration

2727 Mahan Drive

Tallahassee, FL 32308

FAX:  850/488-2520

RE:  Medicaid Reform Complaints

This is yet another letter describing problems experienced by beneficiaries known to Florida Legal Services and Florida CHAIN. Again, as noted in previous letters, numerous other consumers have described complaints at meetings attended by AHCA, CHAIN and Legal Services.  Again, the individual problems illustrated below reflect systemic issues, e.g. incorrect and incomplete information given by choice counselors; nonfunctioning enhanced benefit program; nonpayment of providers, resulting in loss of long term provider/patient relationships; denials and delays in accessing specialists.  And again, there is no doubt that these individuals represent a small fraction of the total number of Medicaid reform beneficiaries who are experiencing problems. 

Howard Kaplan: Broward

Howard Kaplan has blood work done every 3 months.  His plan requires that the word be done at an off site clinic.  In May he received a bill for blood work of over $400.  He told the lab that he has insurance and the test was ordered by his physician.  He was told by the lab that the particular test was not covered outside of a hospital and that he would be responsible for the bill.  Although he explained again that he is required by his Medicaid Reform plan to get his lab work done at that facility and should not have to pay, the lab insisted on a payment plan.

Regarding his enhanced benefit, Mr. Kaplan went to Walgreen’s and CVS to redeem his enhanced benefit, and they said they knew nothing about it.  Even when he showed the pharmacists the letter from the plan stating how much he was entitled to, the pharmacists still claimed not to know anything about the program.  He called the plan number on the bottom of the letter and there was no answer.  He then called the choice counselor and was told to go on the web site. He explained he has no computer.  He asked for a list of the available items under the benefit and the choice counselor refused, saying the list was too long.  The AHCA area agency has intervened, but even with their help the pharmacy offered to help the pharmacy is requiring that Mr. Kaplan provide a prescription for the items he needs, e.g. fish oil tablets, sunscreen.

Finally, Mr. Kaplan’s long term psychiatric nurse practitioner has not been paid by the plan for over 10 months and can no longer afford to see him.  He is obviously extremely upset about losing this long term provider relationship.

Philip Goldstein:  Broward

When Mr. Goldstein, who is blind and has HIV, developed colon cancer, he did not know that his problems were just beginning. Mr. Goldstein was on Medipass when he had colon surgery to remove a carcinoma. Afterwards, he was under the care of an oncologist and a gastroenterologist.

Shortly after his surgery, Mr. Goldstein, received a letter from AHCA telling him that his current provider was no longer available to him and he was being transferred into a Medicaid Reform plan. Goldstein was very concerned because neither of his specialists were part of the plan.  He believed he could change plans and attempted to do so.

Since he is blind, Mr. Goldstein requested a home visit from the choice counselors. The visit was denied and Mr. Goldstein had to hire a service to take him to a choice counsel.  He informed the choice counselor of his new choice.  Although this should have resolved his provider problem, the switch was not made for over 6 months.  During this period Mr. Goldstein was under extreme stress and emotional duress.  He stated at a recent Town Hall meeting that he almost had a “nervous breakdown”.  

U. P.:  Broward

U.P., a severely mentally ill individual, also suffers from psoriasis and needed to see a dermatologist.  He tried to find one in his plan’s Broward network and was told there were none.  The only dermatologist he could see was in Miami.  Unfortunately, U.P. does not have a car and is too mentally impaired to manage public transportation.

David Reid:  Broward

David Reid, who suffered a brain aneurism 25 years ago, has had serious medical problems since that time.  He had no problems with accessing necessary care under Medipass.  Until last June he was able to see all the specialists he needed and he had established several important long term provider/patient relationships. However, once signed up for a reform plan, Reid was unable to see his neurologist.  Also, although his general internist was listed in the plan directory the doctor then dropped out, as did his long-time eye doctor. When he called the plan to report that doctors listed in their directory were no longer seeing patients from that plan and would not see him, he simply told that they are supposed to, but the situation was not remedied.

Mr. Reid has also had problems with the plans’ enhanced benefits. He received a statement regarding the benefit he was due in December but the pharmacist refused to provide it to him and simply referred him to the plan. The plan asked for a list of products they said they would send him. To date he has not received any products. When Reid, upon advice from a choice counselor asked to speak with the Special Needs nurse and commented on how his primary care physician was finding it difficult to deal with Reform, her response was to ask Mr. Reid if he was getting paid to tell her that.

David Mitchell:  Broward

Mr. Mitchell, age 48, has suffered from bone, brain, throat and soft tissue cancer for over 40 years.   He has literally had hundreds of operations and suffers from ongoing pain.  In addition to his oncological and plastic surgeon, he is regularly seen by a pain medication specialist, a cardiologist and a primary care doctor.  He needs to take several prescription drugs, including pain medication which he has taken for years and which cannot be delayed or terminated without causing severe side effects.  Mitchell was initially enrolled in a plan that covered his doctors and medications, however, on or about June 2007.  Due to his complex medical needs, AHCA referred him to the Agency’s “special needs nurse” for advice on which plan to choose, rather than a regular choice counselor. 

Mr. Mitchell spoke with the special needs nurse at length and provided her with the names of all of his providers and medicines.  Based on that information, the special needs nurse disenrolled him from Humana and enrolled him in First Health Choice (THC) effective June 1, 2007.  However, when he tried to fill his medications THC refused to cover several of his prescriptions, including the critically necessary pain medications.  Further, in spite of his understanding that his providers were in the THC network, his pain specialist, Dr. Hale is not.  Mr. Mitchell must see Dr. Hale monthly and has been charged for those visits.  As an SSI recipient he cannot afford to pay for the office visits and is in dire fear that Dr. Hale will no longer see him since his account is in arrears.

Michelle Johnson:  Duval

When Michelle Johnson’s five children were switched to a Medicaid Reform Plan, she was told that they could no longer see their long-time dentist even though he had been providing their dental care – both routine and orthodontic speciality – for many years.  Her Plan did not provide her with a list of dentists. After a time-consuming search, Ms. Johnson found a dentist who accepted the Plan. Within a short time, however, the children’s new dentist stopped accepting the Plan. Ms. Johnson called the Plan and this time the Plan provided Ms. Johnson with a list of their dentists. However, when Ms. Johnson contacted the dentists on the list, she found that none of them were accepting the Plan. When Ms. Johnson’s attorney contacted the Plan, the Plan erroneously claimed that her children had been terminated from Medicaid.  After Ms. Johnson filed a fair hearing the Plan claimed to have secured a dental provider for the children. Ms. Johnson is still concerned that her children will not be seen by this new provider because she was previously told that the same provider is not accepting new patients.  

LaTonya Rigsby:  Duval

Since LaTonya Rigsby and her three children were enrolled in different Medicaid Reform plans,  accessing providers and scheduling appointments is complicated. Further, when Ms. Rigsby has attempted to make appointments for her children by calling the doctors listed on the provider directories, she was told that the doctors were not accepting new patients. 

In May 2007, Ms. Rigsby had severe right knee pain and went to the emergency room.  The ER physician’s discharge orders instructed her to follow up with a specialist.   When she called to make an appointment, the specialist could not see her, even though she was on the provider service network, because she not been seen by the specialist before. She then called her primary care physician (PCP) and was told she could not be seen for a month.  While waiting for the PCP appointment , she damaged her left knee and hip in her efforts to alleviate the pressure placed on her right knee.

Janet Barnett: Broward

A retired nurse who is familiar with navigating the system, she was recently diagnosed with carcinoma of the liver. Being forced to choose a plan under Reform, she chose the one that included her oncologist over the one that included her primary care physician. As part of her treatment, she was required to undergo a cath-lab (the insertion of a tube through the artery to detect and repair arterial blockages), because of severe heart murmurs.  “The one most important thing people with my condition are warned about is to avoid stress,” said Barnett. “You can imagine the stress I felt when I received a bill from the cardiologist for the procedure because the plan wouldn’t pay for it,” she said. This right before having to go back in to receive massive chemotherapy directly to the liver to combat the disease.

Lori x: Broward

Lori, who suffers from severe mental illness and was autoenrolled in November, was recently bounced from one institution to another, as her condition worsened, because the plan she was enrolled in would not pay for services she had previously received. Her mother shared her story at a recent consumer roundtable: “The police took my daughter to Tamarac Pavilion, where she had gone before and was covered by Medicaid. After one day they discharged her because the Reform plan she is in does not cover her there. She was sent by ambulance to a psychiatric hospital where they kept her for a week and discharged with medication that caused her to pass out. So we called her primary care physician who had no availabilities at the time and suggested we take her to Coral Springs Hospital. Unfortunately what my daughter needed at the time was a psychiatrist to evaluate her medications. But no psychiatrist under her plan could see her at Coral Springs Hospital, so she was kept under observation for three days, and eventually they sent a psychologist. Talking is not what she needed.

Florida CHAIN Seeks Stories

Florida CHAIN welcomes contributions from health care consumers who are interested in sharing their experiences with readers of CHAIN Reaction. If you have a story to share, please contact Andrew Leone at 954/684-9895 or andrewl@floridachain.org

---

 

Health Care for All–Florida Informed on Models, and Develops Strategies

Working to gain momentum on issues related to universal health care while expanding its activist base, Health Care for All-Florida recently held an informational meeting at a Coral Gables restaurant. 

The event included a presentation on the Italian system of universal coverage, ranked second internationally by the World Health Organization. The presenter was Andrei Javier, B.A. candidate in Behavioral Neuroscience at Yale University participating in a summer internship with Human Services Coalition. Ms. Javier recently returned from a fact-finding trip to the University of Bologna where she had the opportunity to interview physicians and government officials regarding delivery of care in Italy.

Following Ms. Javier’s presentation, the group engaged in discussions on strategies for legislative and media actions. Health Care for All-Florida supports H.R. 676, the “Medicare for All” bill. Introduced by Michigan Rep. John Conyers, this bill has garnered increased attention on the heels of the release of “Sicko,” Michael Moore’s documentary on the sad state of health care delivery in the U.S.

Among its objectives, in the near future Health Care for All-Florida plans to target specific Florida elected officials as part of a national call-in day of support for HR 676, on Thursday, September 6. The organization will also promote universal coverage at the Florida Democratic Convention in October.

For more information on Health Care for All Florida, visit http://www.hcfafl.org

(submitted by Andrew Leone, Florida CHAIN)

Andrei Javier, B.A. candidate in Behavioral Neuroscience at Yale University and summer intern with Human Services Coalition, discusses the Italian universal health care system she studied on a recent trip to Bologna, with members of Health Care for All-Florida at an August gathering in Miami.

Florida CHAIN Awarded Grant from Health Foundation of South Florida to Expand Medicaid Reform Evaluation

Florida CHAIN received a $50,000 grant from Health Foundation of South Florida to support efforts at including the voice of Medicaid Reform consumers in the evaluation of the program. Health Foundation of South Florida is a not-for-profit philanthropy located in Miami, Florida. Since its inception in 1993, the Foundation has awarded more than $70 million in grants and program support to advance the health status of underserved individuals in Broward, Miami-Dade and Monroe Counties. 

The grant will allow for the development of forums allowing consumers to communicate to legislators in Broward and Miami-Dade counties their experience with Medicaid Reform for the purpose of reining-in its expansion beyond the pilot counties. In addition, the grant will provide consumers with the opportunity to offer input on alternative solutions to Medicaid Reform.

“Since the inception of Medicaid Reform in July 2006, Florida CHAIN has been tracking consumer experiences accessing care.  Many stories have been documented whereby consumers have either been denied and/or delayed care or have not been able to access life sustaining medications, ” said Lisa Margulis, executive director of Florida CHAIN.

According to the terms of the waiver that established Medicaid Reform in the pilot counties of Broward and Duval, the Agency for Health Care Administration (AHCA) must seek legislative approval before expanding the program statewide.

State Events & Notices
     North Florida
     Central Florida
     East Central Florida
     West Central Florida
     Southwest Florida
     Southeast Florida
     Florida Audio & Web Events 
     Statewide Notices
National Events & Notices
     Conferences & Events 
     Audio & Web Events 
     National Notices
     Campaigns & Initiatives

STATE EVENTS & NOTICES

NORTH FLORIDA  

CENTRAL FLORIDA

WEST CENTRAL FLORIDA 

Events

Supported Employment and Benefits Management Training  
Sept 27-28  Miami (Registration Deadline – Sept 25)
For Individuals with Disabilities, their Family Members and Support Coordinators. For information, contact 850/386-2022 or diamondw@wilres.com.

Breast and Ovarian Cancer: Prevention, Diagnosis and Treatment

Notices

FLORIDA AUDIO CONFERENCES AND WEBCASTS

STATEWIDE NOTICES  

Human Services Coalition (HSC) is partnering with the national nonprofit AmeriCorps program Public Allies to develop young diverse leaders in Miami-Dade County. HSC will kickoff the Public Allies program in October, placing 15 local men and women between the ages of 18 and 30 to work with nonprofits as apprentices for 10 months.  During that time, the Allies will participate in leadership and professional skills training and work on a team service project. They will also facilitate community dialogues about local issues. Each Ally will receive full health benefits, a monthly stipend of $1500 and $4,700 at the end of the program to help fund their education.  The project is also funded in part by Allegany Franciscan Foundation and The Children’s Trust. HSC will recruit applicants for the 15 positions over the summer and look for partner organizations to host each Ally. For more information about becoming an Ally or hosting one, contact 305-576-5001 x32.

NATIONAL EVENTS & NOTICES

CONFERENCES AND EVENTS 

Active Living Research Conference Seeks Abstracts

Abstract submission deadline: Sept 17

April 9-12 Washington DC

The theme of this year's conference is "Connecting Active Living Research to Policy Solutions." Abstracts on all topics related to active living policies and environments are welcome. In addition to policy-relevant research, Active Living Research welcomes abstracts about children and adolescents at greatest risk for obesity—African-American, Latino, Native American, Asian-American and Pacific Islander children and adolescents living in low-income communities.

Health Disparities Symposium on Cancer: Addressing the Issues

Sept 24-25   8:30 am-5:00 pm  Durham, North Carolina

This Morehouse School of Medicine event has a two-fold purpose: 1) to address the issues of cancer health disparities among African Americans and 2) to connect the dots (of needed community resources). Ultimately the symposium is designed to address indicators that affect cancer health disparities to include: 1) barriers that prevent access to effective health care, 2) the role of faith-based organizations and leaders in education and prevention, 3) cultural competency, and 4) community partnerships will be focused on at the symposium. The symposium will attempt to link essential entities, needed to address cancer health disparities: academia, community, faith-based organization, and public health.

7th Annual Diversity Challenge at Boston College: Race and Culture Intersections in Scientific Research and Mental Health Service Delivery for Children, Adolescents, and Families
October 2007
Presentations should focus on developments in research, professional practice, education or social justice initiatives as they pertain to promoting the mental health and redressing the mental health disparities for racial and ethnic minority children, adolescents, and families. Researchers, practitioners, educators, medical service providers, employee assistance personnel, government agencies, spiritual healers, and providers of community services are encouraged to submit proposals. 

Community Benefit 101: The Nuts and Bolts of Planning and Reporting Community Benefit

Oct 3-4    St. Louis

Whether you are new to community benefit or want to bring colleagues from finance, planning or other departments up to speed, sign up for the Catholic Health Association's "Community Benefit 101." This program will cover: the CHA accounting and reporting framework which is included as part of the new IRS 990 H, why community benefit is so important today (including recent federal and state government initiatives), what counts as community benefit, how to plan and evaluate effectiveness of community benefit programs and how to tell the community benefit story. Organizational teams are encouraged to attend.

SOPHE 58th Annual Meeting - Partnerships to Achieve Health Equity  
Oct 31–Nov 3   Alexandria, VA
Abstracts are now being accepted online for workshops, symposia, oral presentations, and posters for Society for Public Health Education's 58th Annual Meeting. SOPHE is pleased to be partnering with CDC's Racial and Ethnic Approaches to Community Health (REACH) program and Eta Sigma Gamma for its 40th Annual Meeting.  Sub-themes include health systems change; social determinants of health and transdisciplinary approaches to health education; health communications, health literacy and technology; cultural competence in bridging differences, and; evaluation and dissemination of evidence-based approaches. For more information, contact lvillejo@mdanderson.org

Creating a Culture of Wellness

Nov 27-29   Washington, DC

The U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention (CDC) will host this 2007 National Prevention and Health Promotion Summit. This groundbreaking event will unite health professionals, business entrepreneurs, and government leaders at all levels who are dedicated to health promotion, chronic disease prevention, health preparedness, birth defects, disabilities, genomics, and wellness.

National Congress on the Uninsured: From Practical Local and Regional Solutions to State and National Health Reform

Dec 10-12   Washington, DC

The challenge of the un- and underinsured in America puts great social and economic stress on the nation's health system. The goals of The National Congress are to: define the issue; identify and assess various federal and state health reform proposals; analyze the roles of Medicare, Medicaid and SCHIP in expansion of coverage; describe and compare various international approaches to the issue; identify voluntary, charitable initiatives across the country to address the issue at the local level and assess current obligations and practices of healthcare providers to render care to uninsured patients.

ACHI’s 2008 Spring Training for Health Champions

Conference Dates: March 5-7, 2008  Atlanta

Topic Tracks: Minimizing Chronic Disease: Strategies for Social Determinants; Maximizing Coverage: Proven Programs and Innovative Proposals; Harnessing Data: Health Assessments to Health Outcomes; Delivering Community Benefit: Management Tools and Community Strategies (co-sponsored by Catholic Health Association and VHA, Inc.); Breaking Silos: Public Health and Health System Partnerships

AUDIO AND WEB EVENTS    

September

National Alcohol and Drug Addiction Recovery Month: September
Substance Abuse and Mental Health Services Administration
(800) 729-6686
info@samhsa.gov   www.recoverymonth.gov

National Cholesterol Education Month: September
National Heart, Lung, and Blood Institute Health Information Center
(301) 592-8573
nhlbiinfo@nhlbi.nih.gov   hin.nhlbi.nih.gov/cholmonth

National Sickle Cell Month: September
Sickle Cell Disease Association of America, Inc.
(800) 421-8453
scdaa@sicklecelldisease.org  www.sicklecelldisease.org

Ovarian Cancer Awareness Month: September
National Ovarian Cancer Coalition
(888) OVARIAN (682-7426)
nocc@ovarian.org   www.ovarian.org

Prostate Cancer Awareness Month: September
National Prostate Cancer Coalition
(888) 245-9455
info@fightprostatecancer.org   www.fightprostatecancer.org

National Suicide Prevention Week: September
American Association of Suicidology
(202) 237-2280
info@suicidology.org  www.suicidology.org

STOP A Suicide Today Day: September 10
Screening for Mental Health, Inc.
(781) 239-0071
AKeliher@MentalHealthScreening.org  www.stopasuicide.org

National Farm Safety & Health Week: September 16-22
National Education Center for Agricultural Safety
(888) 844-6322
halversc@nicc.edu  www.nsc.org/necas

Reye's Syndrome Awareness Week: September 16-22
National Reye's Syndrome Foundation
(800) 233-7393
nrsf@reyessyndrome.org  www.reyessyndrome.org

Take a Loved One for a Check-up Day: September 18
Office of Minority Health
U.S. Department of Health and Human Services
(800) 444-6472
info@omhrc.gov  www.healthgap.omhrc.gov

Hearing Aid Awareness Week: September 30 - October 6
International Hearing Society
(734) 522-7200
acmarkey@ihsinfo.org  www.ihsinfo.org

October 
 
"Talk About Prescriptions" Month: October
National Council on Patient Information and Education
(301) 656-8565
ncpie@ncpie.info   www.talkaboutrx.org

Healthy Lung Month: October
American Lung Association
(800) LUNG-USA (586-4872)
info@lungusa.org   www.lungusa.org

Let's Talk Month: October
Advocates for Youth
(202) 419-3420
tom@advocatesforyouth.org   www.advocatesforyouth.org

National Breast Cancer Awareness Month: October
National Breast Cancer Awareness Month Board of Sponsors
nbcamquestions@yahoo.com  www.nbcam.org

National Family Sexuality Education Month/Let's Talk: October
Planned Parenthood Federation of America
(212) 541-7800
education@ppfa.org   www.plannedparenthood.org

National Child Health Day: October
U.S. Department of Health and Human Services
Maternal and Child Health Bureau
(301) 443-2170
www.mchb.hrsa.gov

NDSD Mental Health Screening TM: October 11
Screening for Mental Health, Inc.
(781) 239-0071
ndsd@mentalhealthscreening.org  www.mentalhealthscreening.org

National Mammography Day: October 19
American Cancer Society
(800) ACS-2345   www.cancer.org
 
Respiratory Care Week: October 11
American Association for Respiratory Care
(972) 243-2272
marketing@aarc.org   www.aarc.org/resources/rc_week/

November 
 
American Diabetes Month: November
American Diabetes Association
(800) DIABETES (342-2383)
askada@diabetes.org   www.diabetes.org

Diabetic Eye Disease Month: November
Prevent Blindness America
(800) 331-2020
info@preventblindness.org   www.preventblindness.org

Lung Cancer Awareness Month: November
Lung Cancer Alliance
(800) 298-2436
info@lungcanceralliance.org   www.lungcanceralliance.org

National Alzheimer's Disease Awareness Month: November
Alzheimer's Association
(800) 272-3900
info@alz.org  www.alz.org

National Family Caregivers Month: November
National Family Caregivers Association
(800) 896-3650
info@thefamilycaregiver.org  www.thefamilycaregiver.org

National Healthy Skin Month: November
American Academy of Dermatology
(888) 462-DERM (3376)
mediarealtions@aad.org   www.aad.org

National Hospice Palliative Care Month: November
National Hospice and Palliative Care Organization
(703) 837-1500
jradulovic@nhpco.org   www.nhpco.org

Pancreatic Cancer Awareness Month: November
(877) 272-6226
information@pancan.org  www.pancan.org

Prematurity Awareness Month: November
March of Dimes Birth Defects Foundation
(888) MODIMES (663-4637)
askus@marchofdimes.com  www.marchofdimes.com

Prematurity Awareness Day: November 13
March of Dimes Birth Defects Foundation
(888) MODIMES (663-4637)
askus@marchofdimes.com  www.marchofdimes.com

Great American Smokeout: November 15
American Cancer Society
(800) ACS-2345
www.cancer.org

Gastroesophageal Reflux Disease Awareness Week: November 18-24
(888) 964-2001
iffgd@iffgd.org  www.aboutgerd.org

 
December

World AIDS Day: December 1
Joint United Nations Programme on HIV/AIDS
unaids@unaids.org   www.unaids.org/en/default.asp

New listings, in order of submission deadlines

Continuing listings, in order of submission deadlines

Allegany Community Outreach Grants
Deadlines: Sept 1, March 1
ACOR is a grant program of Allegany Franciscan Ministries, Inc.  It provides short-term support to local community projects. The grant award range is $1,000-$5,000; limited numbers of grants. Priority to organizations for projects that strive to: improve the health, wellness and quality of life through a holistic approach to education or direct service; bring about systemic change and promote self-sufficiency; benefit a disenfranchised segment of society; Sponsoring organization strives to incorporate the viewpoint and participation of individuals who are direct recipients of its services (e.g. service recipients are represented on the governing board).

WHO Foundation: Women Helping Others
Deadline:  second Tues of Sept
The WHO Foundation: Women Helping Others supports grassroots nonprofit organizations in the United States and Puerto Rico serving the overlooked needs of women and children. Specific projects and programs addressing health, education, and social service needs are the Foundation's priority. To qualify for funding a nonprofit organization must have been incorporated for a minimum of three years prior to application. Preference is given to organizations with an operating budget of $3 million or less. Visit the website listed above for more information.

Blue Foundation for a Healthy Florida Winter Grant Cycle 

Deadline: Sept 14

The mission of the Blue Foundation is to enhance access to quality health-related services for Floridians, with a particular focus on the uninsured and underserved. The foundation strategically focuses grant allocations toward philanthropic, community-based solutions designed to improve program capacity and reduce barriers to access. A priority focus for 2007 is to maximize impact in community-based health clinics and outreach services. This focus will help to address the vast challenges associated with providing access to and lasting outcomes connected with populations presently not receiving effective health-related prevention or treatment services. The greatest percentage of the Blue Foundation funding will be to identify, nurture, and sustain such activities to benefit underserved and uninsured populations. For the 2007 grant cycles, requests will generally be considered for proposals from $10,000 up to $100,000. Multi-year commitments of up to three years may be made.

Tobacco Policy Change: A Collaborative for Healthier Communities and States
Application deadline for planning grants: Sept 14

Application deadline for implementation grants: March 14

Tobacco Policy Change: A Collaborative for Healthier Communities and States, a national initiative of the Robert Wood Johnson Foundation, provides resources for local, regional, and state-based organizations and tribal groups to advocate for effective policies that decrease tobacco use and exposure. This initiative is issuing a special solicitation that will build on previous success in attracting new partners whose constituencies are most directly affected by tobacco use and exposure. Grantees are expected to apply their advocacy skills and experience to advance tobacco and other public health policies in their communities. Organizations from Florida are among those able to apply.

Florida KidCare Marketing/Outreach Mini Grants
Phase 2 Hit the Mark Deadlines:  Sept 27

Health & Society Scholars

Deadline: Oct 12

This Robert Wood Johnson Foundation program is designed to build the nation's capacity for research, leadership, and policy change to address the broad range of factors that affect health. Its goalis to improve health by training scholars to rigorously investigate the connections among genetic, behavioral, environmental, economic, and social determinants of health; and to develop, evaluate, and disseminate knowledge and interventions based on integration of these determinants. Scholars must have completed their doctoral training by the time of entry into the program and be citizens or permanent residents of the United States or its territories. Up to 18 scholars will be selected for two-years with annual stipends of $83,000 in year one and $86,000 in year two.

Rural Health Network Development Program

Deadline: Oct 18

To support the development of rural health networks, whose purpose is to increase access to care by overcoming the fragmentation and vulnerability of providers in rural areas. Grant funds are used to support activities that strengthen capabilities of these networks. 

Donors Forum of South Florida on-line database
The new online searchable Donors Forum of South Florida database has up-to-date information about funders in South Florida. This resource— which is also available in hard copy — presents continuously updated information about the giving interests and procedures of funders with a track record of investing in the South Florida area and working collaboratively with others. To order, email leot@donorsforumsf.org or call 305/371-7944. 

Directory Of Health Policy Fellowships

This Kaiser directory contains new listings for undergraduates, graduate students and professionals searching for summer, school-year, or post-doctoral positions.

Florida CHAIN Website Resources

Organizations and Services

Manuals, Guides and Toolkits

Technology and Audio Visual Materials

     Audioconferences and Webcasts

     Media Programming

     Web Sites, Web Features

     Videos and Films

Periodicals and Books

Reports and Studies

     New Listings

        New Listings: Medicaid

        New Listings: SCHIP

        New Listings: Medicare

        New Listings: Federal Budget

        New: Health Insurance, Health Care Costs

        New: Health Equity Issues

        New: Other Health Issues

     Florida Reports

     Medicaid

     SCHIP

     Medicare

     Federal Budget/Health Care

     Health Insurance, Health Costs, Health Care Reform

     Health Equity Issues

     Other Health Issues

FLORIDA CHAIN WEBSITE RESOURCE UPDATE

Florida CHAIN has advocacy tools available online.

Florida CHAIN has updated its website to include more comprehensive and organized information on Medicaid Reform. Click here to view our fact sheet, PowerPoint, and Medicaid Roundtable video clips. Other available resources include Georgetown studies on Medicaid Reform and contact information of members of the Medicaid Reform Advocates Coalition.  

The Florida CHAIN web site now includes resource information in Spanish.

SFCCC works to reduce the cancer burden and cancer disparities in Southeast Florida, including Broward, Indian River, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach and St. Lucie counties. The SFCCC includes representatives from more than 60 public and private organizations, agencies and health care providers, as well as cancer survivor and advocacy groups. SFCCC aims to increase awareness about cancer prevention, early detection, and treatment among populations at high risk. The Collaborative meets quarterly at various locations in the region.

MANUALS, GUIDES, TOOLKITS

Newly posted resources are at the top of the list.

Toolkit: Medicare Private Fee-for-Service Plans

The toolkit contains links to resources on general information about Medicare private fee-for-service plans, advantages and incentives of using the plans and the difficulties that beneficiaries have faced with the plans, including enrollment fraud. The toolkit also includes a list of experts and Web sites for further information on the plans. (7/12/07, Alliance for Health Reform)

Medicare Advantage Tutorial on the basics of Medicare Advantage and types of MA plans, as well as trends in MA enrollment, characteristics of beneficiaries and the impact of MA plans on traditional Medicare. And an updated  Medicare Health and Prescription Drug Plan Tracker with MA plan enrollment data for June, containing local, regional and national data on MA plans and stand-alone Medicare prescription drug plans. (7/17/07, Kaiser Family Foundation)

Race Matters 

This toolkit was created to help advocates and leaders address race and power structures within their work to help create equitable opportunities for all.  (Voices for America's Children and The Annie E. Casey Foundation)

A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations

The guide was created to assist health care organizations in better serving their clients with limited English proficiency and decrease disparities in access to health care. (DHHS Ofc. of Minority Health)

Helping Pediatric Practices Implement Parental Depression Screening
A new online manual helps pediatric clinicians successfully screen parents for depression, discuss with them the impact depression can have on their children, and refer parents for counseling. Rates of major depression peak during women's childbearing years. Research has shown that maternal and paternal depression can affect parenting behaviors and, ultimately, harm children's health and development. Because pediatricians have frequent contact with parents, they have opportunities to screen for depression and intervene when necessary. Accumulating data about the adverse effect of parental depression on child health, development, and behavior have provided an impetus among pediatric practices for changing clinical care.

The Basics of Medicare and Medicaid
The primers help explain Medicaid and Medicare, including an overview, how they work, who they serve and how they are funded. The Medicare primer is new, and the Medicaid primer has been updated with the most current information (Kaiser Family Foundation, "The Basics of Medicare and Medicaid," (3/19/07, Kaiser Family Foundation)

Medicare Rights Center Part D appeals manual
This free, comprehensive, easy-to-understand guide is for advocates who help people with Medicare get the drugs they need.This 25-page manual offers a complete overview of the entire appeals process, real-life case examples from MRC's Client Services department, a glossary of important Part D appeals terms, a sample appeals protocol for advocates, and links to important resources and documents. All in consumer-friendly language

Five Guidelines for Developing Customer-Friendly Websites
This new Covering Kids & Families publication is intended to help state agencies and other organizations do a

better job of helping people find information on the Web about Medicaid, SCHIP and other government services by producing a customer-friendly site.

Amigos en Salud Online Disparities Toolkit
Pfizer has created a free toolkit to help community health centers reduce racial health disparities. The program, called Amigos en Salud/Friends in Health, involves training community health workers to be a bridge between minority communities and the healthcare system. 

Reducing Racial and Ethnic Disparities: A Quality Improvement Initiative in Medicaid Managed Care ToolkitCenter for Health Care Strategies
The toolkit examines the experiences of a workgroup - comprising 10 Medicaid health plans and a state primary care case management association - that adopted strategies to identify and address racial and ethnic health disparities in birth outcomes and immunizations, asthma care and diabetes care. (January 2007)

New/Updated Resources Medicare Drug Plan Resources
In advance of the 2007 Medicare drug plans open enrollment period beginning Nov. 15, Kaiser Family Foundation has issued a series of new and updated resources based on ongoing research including consumer surveys:

Updated fact sheet providing state-specific data about Medicare drug plan options for 2007, including stand-alone drug plans and Medicare Advantage plans, and information on premiums, gap coverage, and availability to beneficiaries who qualify for full low-income assistance.

Updated Medicare Prescription Drug Benefit fact sheet, with a revised estimate that 4 million people will be affected by the coverage gap in 2006, as well as current enrollment and low-income subsidy participation and updated Medicare per capita drug spending.

Updated Talking About Medicare online consumer guide, reflecting 2007 benefit changes, to help people with Medicare and their families understand options and make decisions based on their personal situations; includes information about financial assistance for those with limited incomes, supplemental insurance options, and Medicare Advantage.

The Medicaid Matters web site is a resource for people working across the country to protect Medicaid, the health insurance that 50 million rely on. It stores a ready-to-use toolkit of messages, materials and dissemination ideas. Users are able to download, at no cost, tested messages emphasizing the importance of Medicaid and the threat now facing the program. Messages are enhanced by high quality, full color photography. One set of materials is designed to be ready to print. Once downloaded, they can be forwarded to any print house or copy shop without any further formatting. The second set of materials is designed so that components of the product can be adapted to suit the needs of that organization or constituency that wishes to use them.

TECHNOLOGY AND AUDIO/VIDEO RESOURCES

Videos and Films

Covering Kids & Families Video
Parents' Action for Children, a 2006 national supporter, has created a flash animation video in partnership with Covering Kids & Families that promotes the availability of low-cost and free health care coverage for eligible families. Parents’ Action for Children plans to promote the video to their membership of more than 35,000 parents across the country who are working to improve the lives of children and families in their communities. View the video today! For more information, contact 202/338-7227 or coveringkidsandfamilies@gmmb.com  

PERIODICALS AND BOOKS

Cohn, a senior editor at The New Republic, researched and wrote the book as part of his 2002 Kaiser Media Fellowship. The book weaves a series of originally reported narrative stories with a history of health insurance and a close-up look at the business of medicine in America. It ends by examining proposals for reform and comparing America’s health care system to some systems abroad. Susan Dentzer, senior health correspondent at the NewsHour with Jim Lehrer, will moderate a discussion of the issues raised in the book with Cohn, and Michael Cannon, director of Health Policy Studies at the Cato Institute.

REPORTS AND STUDIES

New Listings

New Listings: Medicaid

New Listings: Medicare

Medicare Prescription Drug Benefit Progress Report

In the first in-depth look at seniors' experiences with Medicare's prescription drug benefit, a new survey finds that the majority of seniors who lacked drug coverage in 2005—before the establishment of the benefit—obtained it in 2006. Even with Part D coverage, however, many seniors reported relatively high out-of-pocket spending in 2006. They were also more likely to skip prescribed medication. (8/21/07, Commonwealth Fund)

The Reluctant Regulator: CMS's Response to Marketing Misconduct by Medicare Advantage Plans
The Bush Administration is unwilling to hold Medicare private health plans accountable for their sales representatives' marketing practices, or to take the necessary steps to stop the plans' widespread marketing abuse, according to a new report. (8/1/07, California Health Advocates and the Medicare Rights Center)

Medicare Beneficiaries Often Cannot Obtain Necessary Medications For 'Off-Label' Uses Through Prescription Drug Benefit
Medicare beneficiaries often cannot obtain medications prescribed for "off-label" uses -- such as the treatment of pain, rare diseases and other conditions -- through the prescription drug benefit, according to a report. (8/6/07, Medicare Rights Center)

An estimated 1.6 million low-income beneficiaries in the Medicare drug program will either be forced to join or be assigned new drug plans by Jan. 1, or pay more for their drug coverage. The reassignments and higher costs will occur because of premium increases and technical adjustments in the drug law (PL 108-173), the group contends. As part of the drug benefit, beneficiaries have received subsidies as high as $33 per month to help cover the cost of their monthly premiums, but because of a combination of subsidy decreases and premium increases, those subsidies will not be enough to cover premiums of existing plans. "The choice? Pay more or change plans." (8/16/07, Families USA)

Medicare Advantage: Required Audits of Limited Value

The Government Accountability Office (GAO) released this report in July outlining the Centers for Medicare & Medicaid Services’ (CMS) auditing process of the costs and consumer benefits of individual Medicare Advantage (MA) plans. The GAO found that CMS had not met the statutory requirement to audit at least one-third of MA plans in the 2001-2005 period. The plans that had been audited by an independent contractor showed a loss of $59 million to CMS, which CMS has claimed it “does not have the legal authority to recover.” The GAO disagrees, claiming CMS has the authority to “include terms in its contracts with MA organizations . . . that would allow it to pursue financial recoveries based on the bid audit results”  (July 2007, GAO)

New Listings: Federal Budget

New Listings: Health Insurance, Health Costs

Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help

Young adults (ages 19 to 29) are one of the largest segments of the U.S. population without health insurance: 13.3 million lacked coverage in 2005. Young adults often lose coverage at age 19 or upon high school or college graduation. Nearly two of five college graduates and one-half of high school graduates who do not enroll in college will be uninsured for a time during the first year after graduation. (8/8/07, Commonwealth Fund)

Health Care Is Priority When Low-Income Workers Choose Benefits

Low-income earners are interested in helping design employment benefits chosen to meet their specific needs and paying attention to their choices could improve health in this population, say authors of a new survey of Washington, D.C.-Baltimore area workers. (8/5/07, Health News Today)

Many Workers Are Underinsured and Unhappy with Health Plan

Many adults are dissatisfied with their health insurance, and 24% of Americans have just bare-bones policies, meaning they are not adequately covered if faced with major medical expenses, according to new research from Consumer Reports magazine. (8/16/07, EmployeeBenefit News)

Lessons from Local Access Initiatives: Contributions and Challenges

This report presents case studies of five notable programs targeting low-income adults under age 65. Some, like Community Health Works in Forsyth, Ga., offer coverage for a limited period of time, often for individuals who seek care after contracting an illness. Others, like Choice Regional Health Network, in Olympia, Wash., manage care for clients with complex needs, chaperoning them through systems they characteristically have trouble navigating. (8/14/07, Commonwealth Fund)

Federal Help Needed In State Health Care Reform Battle

While many states have introduced new and ambitious health care plans in an effort to get citizens insured, some policy experts contend that the combined strength of federal and state governments is needed in order for a reform movement to have real teeth. (8/2/07, EmployeeBenefit News)

Trends in Potentially Preventable Hospitalizations among Adults and Children, 1997-2004
Because of major concerns with both the cost and quality of health care, a priority of policy makers and health care providers is to identify areas where quality improvement and lower costs coincide.  Potentially preventable admissions—inpatient stays that could be prevented with high quality primary and preventive care—are one are where higher quality care can cost less. (August 2007, H-CUP Statistical Brief)

Community Health Centers Hold Answer to Health Care Crisis
Community Health Centers are a bright spot in the public health debate, providing high-quality care while controlling costs and pumping money and jobs into the national economy, said a new report released today on a national press conference call with leading experts on community health care.  (8/6/07, NACHC)

What Should A Country Spend On Health Care?

Per capita health spending across countries ranges by more than 100 to 1, leading many people to ask, "What should a country spend on health care?" This paper discusses four approaches to this question and demonstrates how each approach, in effect, answers a slightly different question, all of which are important to public policy decisions regarding health care spending. (2007, Health Affairs)

People in 41 Nations Are Living Longer Than Americans

Americans are living longer than ever, but not as long as people in 41 other countries.  For decades, the United States has been slipping in rankings of life expectancy, as other countries improve healthcare, nutrition and lifestyles. (8/12/07, AP)

Action on the Social Determinants of Health: A Historical Perspective

A renewed concern with social factors has emerged in global public health, spearheaded by the World Health Organization's Commission on Social Determinants of Health. The coming decade may see significant health gains for disadvantaged populations if policies tackle the social roots of health inequities. To improve chances of success, global action on social determinants must draw lessons from history. (July 2007, Global Public Health)

Fewer Minority Men Have Undiagnosed Diabetes

U.S. black and Hispanic men are now no more likely than whites to have undiagnosed diabetes, researchers say - suggesting that recent prevention and education efforts are paying off for these hard-hit groups. (8/14/07, HealthDay News)

Immigrants and Health Care - At the Intersection of Two Broken Systems

This perspective piece discusses costs associated with health care for uninsured immigrants, both documented and undocumented, in the U.S. It also discusses immigrants' access to care and the effects of immigration laws on that access, as well as local governments' efforts to expand health coverage to undocumented immigrants (8/9/07, New England Journal of Medicine)

Preventive Care: A National Profile on Use, Disparities, and Health Benefits

This is a follow-up study to a 2006 Partnership for Prevention report which ranked 25 evidence-based clinical preventive services recommended by the U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices based on service's health impact and economic value. Increasing the use of just five preventive services would save more than 100,000 lives every year in the U.S., according to a new study released today by Partnership for Prevention. That includes 45,000 lives that would be saved each year if more adults took a daily low-dose aspirin to prevent heart disease. The new study, funded by the federal Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation and the WellPoint Foundation, found that a few measures such as more adults getting flu shots and being screened for cancer could save tens of thousands of lives each year in the United States. The study found serious deficiencies in the use of preventive care for the nation as a whole -- and particularly troubling shortfalls among racial and ethnic populations. (8/7/07, National Commission on Prevention Priorities)

The Psychosocial Effects on Health of Socioeconomic Inequalities

Socioeconomic inequalities are thought to impair health in a way that is independent of the effect of material deprivation on health. But the mechanisms whereby inequalities have such an effect have not been thoroughly explained or explored. Two linked but distinct mechanisms have been suggested: social comparison and hierarchical conflict. June 2007, Critical Public Health)

Lessons from Local Access Initiatives: Contributions and Challenges

Community health initiatives—locally crafted responses to health care access problems—have been steadfast in their efforts to connect uninsured and medically indigent people to health care services and health insurance. These programs assist in outreach, coordinate and integrate care, and help clients use limited resources efficiently. This report offers five case studies of community health initiatives. All five local community initiatives seek to improve access and coverage for those most likely to be uninsured: low-income, nonelderly adults. (8/14/07, Commonwealth Fund)

From Policy to Action: Addressing Racial and Ethnic Disparities at the Ground Level

This report outlines practical strategies that states and managed care organizations are implementing to address inequalities in care. It highlights the need for standardized collection of race, ethnicity, and language data; culturally competent approaches; and the participation and commitment of multiple stakeholders. The brief draws from CHCS' national initiatives, supported by The Commonwealth Fund and the Robert Wood Johnson Foundation, to identify realistic solutions to reduce health care disparities and improve quality. (8/24/07, Center for Health Care Strategies)

Study: Religious docs not likelier to treat poor
This study found that religious doctors are no more likely than nonreligious doctors to care for underserved populations, including the poor, the uninsured or people with Medicaid. The study asked a series of questions about the role religion and spirituality play in the lives of the participating doctors. (July 2007, Annals of Family Medicine)

Lessons from Local Access Initiatives: Contributions and Challenges
The report examines the factors that support or hinder community efforts to improve access to health care and coverage for low-income uninsured adults, based on a study of five local programs. While such programs can support or complement state public and private insurance programs, the authors say they are unlikely to thrive independently. (8/14/07,  Commonwealth Fund)

Immigrants and Health Care — At the Intersection of Two Broken Systems

For recent immigrants — especially the estimated 12 million who are here illegally — seeking health care often involves daunting encounters with a fragmented, bewildering, and hostile system. The reason most immigrants come here is to work and earn money; on average, they are younger and healthier than native-born Americans, and they tend to avoid going to the doctor. Many work for employers who don't offer health insurance, and they can't afford insurance premiums or medical care. (8/9/07, New England Journal of Medicine)

From Lifestyle to Social Determinants: New Directions for Community Health Promotion Research and Practice

Health promotion provides a powerful tool for improving health in the 21st century, but researchers and practitioners have yet to achieve consensus on its scope. Globalization, urbanization, an aging population, and rising rates of chronic diseases are creating new health challenges throughout the world. How can health professionals respond to these changing circumstances? What are the relevant paradigms for promoting health today? How can universities help move health promotion into a new era? (July 2007, Preventing Chronic Disease)

New Listings: Other Health Issues

Florida Reports

Waving Cautionary Flags: Florida’s Experience with Medicaid Reform: Reactions from Doctors and Patients

The latest briefing paper on Florida's Medicaid reform programs shows one out of four physicians are declining to participate and those who remain are seeing fewer patients. View the briefing paper  Or view a presentation of the research.  (May 2007, Georgetown University Health Policy Institute, released by the Jessie Ball duPont Fund, The Community Foundation in Jacksonville and United Way of Northeast Florida)

Florida Children’s Action Agenda 2007/2008 Available Online
Florida state Senators Nan Rich and Durell Peaden and Representatives Loranne Ausley and J.C. Planas have released the final recommendations of the 2006 Florida Children’s Summit.  The Summit participants learned a lot, and the next Summit in Fall 2008 will reflect that.  In 2008 they will spend substantially more time in workshops hashing out recommendations and will secure experienced workshop facilitators who are knowledgeable about the topics they are facilitating.  Also, they will institute a process to ensure that when leaving the 2008 Summit - or very shortly thereafter - all will know the Summit recommendations. 

Miami-Dade and Monroe County 2006 Health Profiles
Health Council of South Florida has released downloadable Health Profiles that provide answers to 10 commonly asked questions about county demographics, health needs, and resources.

Florida Health Insurance Coverage of Children 0-18 (2004-2005)
Kaiser Family Foundation has released information about this on-line resource. 

Medicaid Changes: What will they mean for Broward and Duval counties, and beyond?
This document is Briefing #1 by researchers at Georgetown University’s Health Policy Institute engaged in a two-year evaluation of the Medicaid reform pilot counties for both Florida counties. The evaluation is assessing how these changes affect Medicaid beneficiaries’ ability to access needed care as well as the impact on community health providers.(September 2006, Georgetown University Health Policy Institute)

Report looks at uninsured in Florida
This report from the Research Institute on Social and Economic Policy at FIU documents and breaks down Florida's uninsured figures, finding 18.5% of the total Florida population uninsured. The report looks at employment and industry data related to lack of coverage, and proposes a partial solution.

Insuring All Children -- The New Political Imperative 
This report discusses the history of SCHIP and its effect on access and quality, as well as the debate in Congress over reauthorizing and expanding SCHIP, which expires on Sept. 30, and  the Bush administration's proposal to restrict program eligibility to children in families with annual incomes less than 200% of the federal poverty level. (7/5/2007, New England Journal of Medicine)

Health Insurance, Health Costs

Increase in Prescription Drug Cost Sharing Associated With Lower Rates of Drug Treatment, Adherence 

A review of previous studies indicates that an increase in prescription drug cost sharing is associated with a decrease in drug spending and use of pharmacies; and for some chronic conditions, higher cost sharing is associated with greater use of expensive medical services. (July 2007, Rand Corp., published in JAMA)

The rising cost of healthcare continues to be one of the primary challenges for employers.  It is estimated that in 2005, just over 16% of the gross domestic product was spent on healthcare in the United States, up from 13.8% in 1993...commensurate with the increase in healthcare costs, employment-based health insurance premiums have more than doubled since 1997. (June 2007, Unum Group) 

Health Equity Issues

Key Facts: Race, Ethnicity and Medical Care, 2007 Update

This updated quick reference source on health disparities presents the best available data and analysis, ncluding data on the uninsured and access to care by race/ethnicity as well as information about the isproportionate effect that specific conditions such as diabetes, HIV/AIDS, and asthma have on racial and thnic minority populations in the U.S. New in the 2007 Key Facts are demographic data on the racial/ethnic minority population in each state and the U.S. territories. This edition of Key Facts also includes data from the National Healthcare Disparities Report, examining changes in health care disparities over time.  (Jan 2007,

Kaiser Family Foundation)