It can be a pain to change health insurance policies.
Imagine doing it for 3.5 million Floridians. Right now, the state's moving its medical insurance program for the poor to a new system. By August first, nearly all Medicaid recipient plans will be run by private insurers.
Justin Senior is the administrator overseeing Florida's Medicaid transition. He knows most people worry about health insurance only when they get sick.
“The typical Medicaid recipient is a healthy 9-year-old or 10-year-old", explained Senior. "They’re not receiving medical care on a daily basis. They may have doctor’s appointments. But ultimately they don’t receive medical care on day one of the rollout.”
Still, he's got to grab the attention of one and a half million Floridians being asked for the first time to pick a plan from thirteen pre-approved insurers.
He's also contacting another two million recipients already signed up with private insurers as part of a pilot program. They also got letters from the state, asking if they want to stay or change.
Adriana DeJesus of St. Petersburg doesn't remember any letters. Her kids - six-year-old Angel, and son, Christian - have Medicaid plans under the pilot. Medicaid was critical when the now-five-year-old boy was diagnosed with asthma.
“And when he was a baby, baby, we went to the doctors probably at least three times a week, So they knew us there already", DeJesus said. "They already knew who he was. And so the doctor was just really important because he was always sick from ear aches to sore throats.”
Her kids still see doctors, just less frequently. That may be why she didn't notice the state's letter. She's scrambling to decide whether to keep her current plan or find another that includes Christian and Angels' doctors.
“But I didn’t even know there was a better one, or what happens when if you do change", said DeJesus.
More than half of those enrolled in Florida Medicaid are younger than 21. Moms, Dads or grandparents are making these decisions. So far, 40 percent of Medicaid enrollees failed to pick a plan. A state computer assigned them to one.
Rosy Cozad is CEO of Amerigroup, which offers plans along the state's I-4 corridor. She says it's hard finding Medicaid enrollees who aren't visiting doctors regularly and move frequently.
”Are there hiccups along the way and things that need to be tweaked? Absolutely", Cozad said.
This transition started in 2011, to save money in a program costing the state $22 billion dollars a year. Insurers will get paid from that enormous pot by making sure enrollees get regular checkups. Cozad says insurers are required to provide counselors who monitor member's health, something people with commercial insurance might envy.
“I would love to have a concierge service where I have a case manager who knows all my health care needs, all about my providers and can help me navigate the health care system”, said Cozad.
Not everyone involved in this transition are kids with minor medical needs. Some Medcaid enrollees have chronic conditions handled by the state's Children's Medical Services program. Some pediatricians are worried the financial incentives could hurt the quality of these life-saving services.
Chris Paterson is chief executive of Sunshine Health,a Medicaid private provider that will be handling the medically fragile children in Florida's foster care system. He says Sunshine is partnering with social workers in the state's community-based care network - or CBCs.
He says this new coordination will improves attention to these vulnerable children.
“So the health care now will be integrated", Paterson said. "And the information that everyone needs to make sure that the children’s health care needs are being met are being orchestrated in this relationship between the CBCs and Sunshine Health.”
Sunshine Health, like others involved in the managed care transition, are not new to Medicaid. But in order to attract more business, the new managed care plans offer more options for treatment.
“The networks now that those plans have are significantly broader than the networks that they used to have", said Senior. "And they may notice that there are additional benefits that weren’t available to them before.”
Right now, Adriana DeJesus isn't excited by these extras. She just wants to her kids to stay healthy.