Everyone should have the freedom to choose private care. I have started a petition for the elderly and the disabled in FL who cannot choose private Home Health Care agencies amid Medicaid providers unable to guarantee service. The most vulnerable group in our society is suffering and dying due to criminal practices that have allowed predatory entities to manage their care.

Disability rights of Florida recently has released a short documentary showing the failed system and the long wait times for the LTC program. Unfortunately, people like my mother even after going thru the wait times are not guaranteed services. The system has to change, waiting list of over 12yrs to get approved are unacceptable. But what should be criminal is finally getting approved, only to find out the insurance agencies and their health care agencies will not guarantee service. "Disability During a Pandemic"

Florida is ranked the worst state for LTC in the country costing an average of $100k a year. Fix the LTC program and allow the elderly, disabled and family members to manage their own care. Remove the “middle-men” and provide all funding to these members directly.(https://www.forbes.com/sites/nextavenue/2020/11/09/why-is-florida-the-worst-state-for-long-term-care/?sh=133e606760d6 

Since 2011, Florida Medicaid recipients have been forced to use the Florida Statewide Medicaid Managed Care (SMMC) program. Because of this program, the Agency for Health Care Administration (AHCA) and Department of Elder Affairs changed how individuals receive their long-term care from the Florida Medicaid Program.

Since Covid, LTC recipients have been suffering due to the lack of services which they have been medically approved for. These Medicaid providers like Sunshine Health claim they cannot guarantee services and their Home Health agencies cannot guarantee caregivers/care for these members. The most vulnerable population, the elderly and the disabled are being left without care yet are not allowed the opportunity to get care from private providers that do have caregivers and can provide services for them.

This is the biggest scam in Medicaid history. These plans receive budgets with tax payers money yet are not held responsible to provide the services they are getting paid for. If hospitals could not guarantee service for a patient, yet charged their insurance in advance, that would be considered fraud. If doctors and emergency rooms could not guarantee services to people, why should they remain open? Sunshine Health and all plans receiving money should make sure their providers can and will provide services to those who have gone thru a long process. Many of these recipients wait years in order to get approved to long term care only to find out that their situation will not change.

I have personally tried to reach AHCA, the department of Health, Medicaid, Department of Elderly affairs, the offices of DeSantis and every single individual in the house of representatives for my area. Not one person/organization for the past 3yrs have been able to pressure Sunshine Health to find a provider for my mother who suffered a stroke that left her with full right side paralysis, unable to speak/read/write, suffers from seizures and chocking due to the stroke. We have been forced to stay with a system that will not guarantee services, will not make the plan responsible to provide services and will not allow us the family to choose a provider that is private. Florida has 5 “insurance providers” in our area, why don’t you simply change to another insurance provider you might ask. The answer is simple, because by changing/switching the new provider cannot guarantee that my mother will receive the hours she currently has. To give you an idea, it took us 4yrs to receive the medically necessary hours for my mother. She was initially approved 13hrs a week! Someone who needs help 24/7 is now approved for 12hrs a day. When you have someone that truly needs care, 2hrs of care a day are simply not enough. Family members have to work and many like myself are sacrificed by this system into providing services putting into jeopardy our own health and finances.

Why should a system like the Florida Statewide Medicaid Manage Care program exist?  Why do we need to give money to companies that benefit from not providing services? The less services they provide, the more money they keep. That means bonuses for those higher ups and their staff. All the organizations set in place have failed the elderly and the disabled by allowing predatory companies to gain wealth by the sacrificing their members.

Red Flags:

Sunshine Health claims via member services (supervisors, case managers and representatives) that they cannot "guarantee service" and their providers cannot guarantee service as well. Sunshine Health will never allow a member to record conversations nor provide these statements in writing. AHCA states they do not regulate Sunshine Health only the caregiving agencies (what???) and since Sunshine Health has not denied these members hours nothing can be done. Denying services means denying an application, failure to not provide services is not punishable.

Failure from Sunshine Health to regulate agencies (their "workers") and make sure they will guarantee services to members is non existent. Just how Sunshine Health claims they cannot guarantee service, their providers also state they cannot guarantee service. (In a normal world, if your company cannot guarantee service what do you think would happen?)

Failure from Home Health Agencies to send caregivers for interviews prior to shift starting, provide paid training and regulate their schedules. Caregivers are considered independent contractors therefore they get to "pick and choose" their cases. For example, an elderly woman needs help with groceries, needs help with light housekeeping and companionship, hourly rate $15hr this case will be staff quickly. A 60yr old stroke patient with right side paralysis needs help with transfers, shower, dressing, meal prep and companionship hourly rate $15 (yes, you read right. All cases are set at $15) this case will not get staff. Why would a caregiver choose this case over the easy one for the same hourly rate? 

Failure from Home agencies to regulate their caregivers’ schedules (caregivers are free to decide if they want to show up to work as they are "independent" contractors). These caregivers are not FL licensed therefore reporting them to the department of health will not do anything. Caregivers can be enrolled in unlimited agencies therefore if they get in trouble with one, they jump to the next one without any legal issues. If doctors and nurses where allowed to do this, hide their malpractice by simply going to a different hospital we all would be in trouble!

Failure from home agencies to properly train their caregivers and have them ready to start shift at client's home (as of now, agencies expect family member to provide unlimited training. This has become an endless cycle as agencies change caregivers daily. It should be the agency responsibility to train their staff. A proper family interview should be a must. Just how we go to a job interview to determine if we want the job, like the company and have the proper skill set to do the job; family members need to have this opportunity as well. As of now, care is tailored to what is best for the agency (cheap unskilled labor) not what the patient truly condition/needs are. The "take it or leave it" attitude with this type of service needs to stop. The way this system is been handled is as if clients are getting charity care from these agencies. This is a job where they are providing services and getting paid.  As of right now, caregivers have no liability and can do or not do as they please. They can work with several agencies and put patients in danger or do many violations as they cannot be reported. Even if they are reported to the agency set in place, they simply go and sign up with another agency. There needs to be a database by state of all caregivers. All caregivers need to be CNAs at a minimum with field training (have them train in hospitals, PT therapy places). These people are dealing with the elderly and disabled and need to be well trained. As of now, agencies send them blind to care for our loved ones. 

As you have read all the flaws this system has, why not simply stop it once and for all? The Florida Statewide Medicaid Managed Care (SMMC) program is obsolete and no longer serves the purpose to provide services to those in need. Get rid of all these insurance companies that cannot guarantee services and restore power to the people by allowing them to choose an agency of their own. Create a budget/account per member where all these services are paid from (just like the EBT system) only this time members have the ability to choose their private pay. If these insurance agencies are getting an hourly rate of $25.00 or more, have this deposited into the member's EBT account or create a new type of service account where these private home health agencies can get paid to. Invoices and help from doctor offices will simply replace these plans, case managers and supervisors that only charge the system without providing care for our loved ones. Remove the second and third expense from the system and provide all these services directly to the member. This will not only better care for the elderly and the disabled, it will create incentives for caregivers by providing them a good salary and room for growth.