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Access to Health Care/Rehab Services
In Florida and the United States of America, most Americans have access to health care or rehabilitative services. Throughout many countries of the world, this is clearly not the case. Americans are living longer because some of the serious illnesses of the 20th century have either been eradicated or easily treated. The key is having the ability to see a doctor regularly or have ready access to care when a potentially serious condition arises or in case of an emergency. For those with disabilities, there is a need for access to rehabilitation that will help them lead life as normally as possible. Access to health care and rehabilitative services is primarily a function of having health insurance.
Why Is This Important?
The uninsured are much less likely to obtain needed health care. Over time, the lack of access to primary care and preventive services can lead to chronic illness, acute health crises, and can increase utilization of emergency departments and inpatient hospital services. For the workforce, lack of health insurance and poorer health can lead to lower productivity. For the health care system, the uninsured put a strain on local resources to provide care without repayment. The costs of uncompensated care are passed along to other medical care consumers and payers.
In Florida, Medicaid costs accounted for 20 percent of the state's total expenditures in the fiscal year 2006-2007. Cost per Medicaid beneficiary and the number of Medicaid beneficiaries are the two critical factors impacting the State's Medicaid budget. These factors affect the funding needed for the Medicaid program and the resources the State has available for other programs.
Lack of access to adequate pre-natal care is one of the most significant contributors to problems such as low-birth weight babies. Medicaid is a payer of last resort serving the most needy and vulnerable in Florida. Without Medicaid, more than half the women giving birth in Florida would be without a regular source of pre-natal care.
The role of the emergency department in the delivery of health care is critical. The emergency departments often provide the first line of response to life-threatening injuries. However, the emergency department also serves as the primary health care provider for the uninsured, underinsured and for those who have limited access to primary care providers. Because the emergency department serves as the provider of last resort, analysis of usage of emergency departments can provide essential information about the trends in utilization.
People on the waitlist for the Developmental Disabilities Medicaid Waiver have been determined eligible for services from the Agency for Persons with Disabilities. However they have not been added to the Developmental Disabilities Medicaid Waiver Program. People in crisis are given first priority and youth from the child welfare system are given second priority over others on the waitlist for waiver enrollment. It is important for Floridians with disabilities to gain access to state services in order to have the opportunity to lead more productive lives.
How Is Florida Doing?
According to U.S. Census estimates, in 2007 Florida ranks 47th out of the 50 states in percentage of population having health insurance. That same year, 27 percent of children under 200% of the Federal Poverty Level in Florida were without health insurance.
According to state comparison tables available from the Kaiser Family Foundation for fiscal year 2005, the nationwide average percent of the population on Medicaid was 20 percent and the percent in Florida was 17 percent. Florida ranked 41st by percent of population enrolled in Medicaid. Florida ranked fourth in total number of persons enrolled in Medicaid and fourth in total population. Florida ranked 39th in Medicaid payments per enrollee per year. The nationwide average payment per enrollee in that year was $4,662 compared to $4,389 in Florida, placing the state at 94 percent of the national average.
Medicaid pays for more than half (52.9 percent in 2006) of all deliveries in Florida.
In 2007, the majority of the services delivered in the emergency department were classified as treatment for patients with low and moderate levels of severity (71 percent). This factor continues to be a challenge to Florida's health care delivery system.
Florida operates one of the largest developmental disabilities programs in the country. Due to demand for services and limitations in available funding, it is not uncommon for states to have waiting lists. There are slightly less than 30,000 Floridians receiving services with a waiting list of 18,900 that has increased over the past three years. Once a person is enrolled, the care complements the services provided to them under the Medicaid State Plan and other community services to meet the medically necessary needs of the individual. The state continuously re-evaluates the effectiveness and efficiency of its programs in order to meet the needs of people already receiving services and add new people to the program.
The Home and Community Based Program provides funding for a number of medically necessary services. The Family Supported Living Program provides funding for a more limited array of medically necessary services.
Florida also operates the Consumer Directed Care Plus Program, an innovative approach that allows individuals receiving services, or their guardians, to have an active role in developing and managing their plans of care to address medically necessary needs.
Scorecard
What Influences Access to Health Care/Rehab Services?
The number and percentage of the Uninsured is influenced by the availability and affordability of employer-based health insurance.
The eligibility policy of individual states is a major factor in the percent of the population that are enrolled in Medicaid. Because Medicaid eligibility is income and/or asset based, economic factors such as the state's unemployment rate and economic base influence enrollment. A state's demographic structure or age distribution may also be a factor. Florida has a higher percentage of older adults than other states which increases the number of people needing nursing home care, home health care, and other types of related care. Many of the elderly not initially enrolled in Medicaid may eventually become Medicaid eligible after extended illness or incapacitation.
The major factors causing growth in annual costs per Medicaid eligible are increased costs of prescription drugs, medical and long-term care services. Inflation is a primary driver in the increase of medical costs, and this factor is reflected in the cost per Medicaid eligible. In general, medical costs have increased much more rapidly than average rates of inflation for other goods and services.
Ultimately, the number of Medicaid-funded births and number of uninsured children are influenced by the availability and affordability of employer-based health insurance.
Each year, the number of individuals who can be added to the Developmental Disabilities Medicaid program from the waiting list is influenced by several factors. These factors include:
• Funding availability
• Legislative requirements
• People in crisis having the first priority to be added to the program
• Children in the child welfare system having the second priority to be added to the program
What Is the State's Role?
At present, the state's major roles include helping to support community access to health care through special programs and health centers, developing innovative ways to provide health care through local partnerships, providing coverage to low-income children, pregnant women, and disabled children and adults, and supporting the State Children's Health Insurance Program (SCHIP) also known as Florida KidCare.
The state's fundamental role is to provide health coverage to people with low incomes and improve their health. Without this coverage this population might otherwise be uninsured and be without medical care for themselves and their families.
The state also provides outreach and education, family planning, health screening, and pre-natal and birthing services to low-income and/or at-risk women. In addition, the State helps to support community access to health care through special programs and health centers, developing innovative ways to provide health care through local partnerships, providing coverage to low-income children, pregnant women, and disabled children and adults, and supporting Florida KidCare.
Emergency rooms are a vital component of the health care system and the increasing utilization for non-emergency care poses challenges to Florida's health care delivery system. The State's role is to address the increasing utilization and associated costs in regard to the utilization of emergency department services for non-emergencies to lessen the strain on Florida's emergency departments.
Support for persons with developmental disabilities in living, learning and working in the community is provided by the state. Florida strives to effectively support people with developmental disabilities to empower them to be valued and contributing members of their community.
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