Health Care

Medicaid program focuses on care of mentally ill

Claudia Lamazares, chief operating officer, Magellan Complete Care of Florida
Claudia Lamazares, chief operating officer, Magellan Complete Care of Florida

Suffering from severe and sometimes debilitating depression since she was a teenager, the diabetic South Florida woman had not seen her psychiatrist in months — let alone her primary-care doctor — and had long since stopped taking her medications.

The woman, now in her 40s, is one of thousands of Floridians who are being helped by Magellan Complete Care of Florida, according to its chief operating officer, Claudia Lamazares. Magellan won a five-year contract from the state’s Agency for Health Care Administration to set up a comprehensive health plan tailored to Medicaid recipients who suffer from mental and behavioral illnesses. It is the only such program in the country.

One of Magellan’s newly hired healthcare workers, Lamazares said in an interview last week, was able to establish a rapport with the woman and help her set up appointments with her doctors, and to make sure she showed up.

The woman told the “health guide” who tracked her down that she had previously been hospitalized on 12 occasions in a single year, although most years her admissions ran to three or four.

“The biggest thing these people need is support to be able to take care of their health,” Lamazares said. “Our mission is to really engage them in their care.”

The woman’s story illustrates the kind of work the for-profit company says it is trying to do for thousands of mentally ill people in Florida who are on Medicaid, the state-federal plan that provides healthcare coverage for low-income Americans. Florida has the dubious distinction of ranking 49th in the country in per capita spending on mental health, according to the National Alliance on Mental Illness.

The plan is part of Florida’s effort to move about 3.6 million Medicaid recipients to managed-care models, which legislators believe will cut costs. Although legislators in Tallahassee expanded mental health funding in the 2014-15 state budget — including more money for Crisis Support Units and the Community Action Team program — the state is still operating with Medicaid reimbursement rates that “have not been increased in 20 years,” said Mike Hansen, president and chief executive of the Florida Council for Community Mental Health. Boosting those rates, he added, is one of the council’s top lobbying priorities in the 2015 legislative session.

“We believe that mental health services are inadequately funded in Florida,” said Hansen.

The Magellan program, established in 40 of Florida’s 67 counties, including Miami-Dade, Monroe, Broward and Palm Beach, anticipates signing up between 30,000 and 50,000 patients before the end of this year. In many cases, the real work begins long before a patient’s illnesses can be treated. The first task might simply be tracking them down.

“We might just have an address,” said Lamazares, who is based in Miami but whose corporate headquarters are in Scottsdale, Arizona. “We locate them, we knock on doors. Sometimes, they don’t remember who their doctor is. These are people who are lost to care. We’ve found people who haven’t seen a doctor in six, seven, eight months.”

An important aspect of the program, she said, is its recognition that many people suffering from mental illnesses have physical afflictions as well. They often take the form of smoking-related lung diseases, obesity and diabetes, conditions that are sometimes inadequately treated when the focus of care is directed toward a patient’s emotional problems.

“They may have two or three physical health issues beyond mental health issues,” Lamazares said. “Our model takes into account the whole person.”

The goal? To keep the person being treated “out of the street, and out of the revolving door of hospitals,” she said. Such patients can “avoid deteriorating” and become what she called “more self-directed and able to make good choices.”

Magellan’s chief medical officer, Dr. Charles Cutler, said the program’s health workers promote communication between providers to coordinate treatments. The system also prevents unnecessary expense, he said.

“A number of the medications used to treat severe mental illness can raise blood sugars in a diabetic,” Cutler said. “Normally, if a psychiatrist takes care of schizophrenia, he won’t necessarily take care of diabetes. So we try to put everything together in a care plan.”

Cutler and his colleagues began hiring employees for the program — nurses, social workers, health guides, internists, therapists — in March, with the first members enrolled in July.

“We help them get the care they need before they have to be hospitalized,” Cutler said. “We don’t wait for an acute event to reach out to our members. And if they do have to be hospitalized, we’re involved in helping to plan their discharge.”

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.