51,000 children will have to change health plans

By Christine Jordan Sexton
9/16/2008 © Florida Health News

Some 51,000 children in the Florida Healthy Kids program this fall will have to change HMOs, and possibly doctors, in the largest turnover of health plans in the history of the children’s health insurance program.

Robleto

The changes, which will take effect Oct. 1, occurred after the Florida Healthy Kids Corp. asked HMOs across the state to bid on the program. It was the first time that the program, which had more than 205,000 children enrolled as of May, had requested bids for all 67 counties.

“We are trying to make sure we have the best HMOs in all of our areas,’’ said Rich Robleto, executive director of Florida Healthy Kids.

Children in Volusia County are most affected by the change. About 6,300 Florida Healthy Kids enrollees in that county will be moved from the Florida Health Care Plan HMO to the United Healthcare HMO.

Amerigroup will pick up 4,426 children in Brevard County and another 4,068 children in Seminole County.  Another 3,255 children in Sarasota will be moved from Staywell to United Healthcare. (Editor's note: An earlier version of this story was in error when it reported that Staywell instead Amerigroup was selected to serve Brevard and Seminole Counties.)

There were no changes made in the plans serving heavily populated Broward, Duval, Hillsborough, Miami-Dade, Orange or Palm Beach counties.

Florida Healthy Kids sent letters to the families of about 51,000 children the last week of August advising them of the change, said Jennifer Kiser Lloyd, chief external affairs officer for the program. 

For a complete list of counties and their health plans, see this chart provided by the Healthy Kids Corporation. The counties where plans will be changing are shown in yellow.

The change won’t affect the types of benefits that are covered because those are required by law, but it could impact access to physicians. It could also mean changes in prescription drug benefits and prior authorization policies.

To help prevent problems, the Florida Healthy Kids Corp. requires the incoming health plans to coordinate care with the outgoing providers.

While new plans are not required to change their networks or policies, Healthy Kids officials have encouraged them to work on identifying area doctors and other health care providers who see large numbers of children and try to get them signed up for the new plan’s network.

Lloyd said the HMOs also have been encouraged to share information on long-standing prior authorizations or referrals.

“Anytime you have a change in plans, you want to makes sure you cover all the bases,” Lloyd said. For most families, she said, the overriding issue will be whether their primary care physician is in the new HMO network.

“There is a great deal of overlap. It may be possible the provider is a member of the new plan coming in,’’ she said.

Christine Jordan Sexton can be reached at ChristineSextonWork@hotmail.com.