Miami-Dade County

Medicaid managed care still posing barriers for deaf, disabled

Jacqueline Salcedo, a sign language interpreter, communicates with the hearing impaired at a meeting Friday between the Center for Independent Living of South Florida, people with disabilities, and the Agency for Health Care Administration (AHCA) discussing issues the disabled community has faced in the transition to Medicaid managed care.
Jacqueline Salcedo, a sign language interpreter, communicates with the hearing impaired at a meeting Friday between the Center for Independent Living of South Florida, people with disabilities, and the Agency for Health Care Administration (AHCA) discussing issues the disabled community has faced in the transition to Medicaid managed care. MIAMI HERALD STAFF

Six months after Florida rolled out its Medicaid managed care program — transitioning almost 3 million Floridians into private insurers — some recipients with disabilities say the new model hasn’t fixed some of the old problems.

Last week, about 30 people from the disabled community gathered at the Center for Independent Living of South Florida to discuss complaints about access and communication, ranging from lack of American Sign Language interpreters at doctor’s offices to confusing paperwork.

Marc Dubin, director of advocacy for the Miami-based branch, has spent the past 10 years trying to ensure that barriers to access for the disabled — especially the deaf — were eliminated in Florida’s Medicaid managed care system. But he said problems still arise “at every level of the healthcare system from making appointments, to communicating with their doctors, to receiving discharge information, to receiving prescriptions.”

At the meeting, Dubin spoke on behalf of the disabled community to managed care companies and state Medicaid leaders on a conference call while attendees flicked their fists and nodded their heads — the American Sign Language symbol for “yes.”

“We cannot just sit around not understanding forms, not understanding our doctors,” said Damis Fellove, a deaf Miami man who spoke through an interpreter.

Under the privatized Medicaid system, the Agency for Health Care Administration has oversight of the managed care program and sets requirements for companies, including provisions for ease of communication.

Justin Senior, deputy secretary for Medicaid at AHCA, said the agency tries to address any complaints that come up.

“Everybody here is committed to making sure our communication is effective,” Senior said.

Consumers can file complaints with their managed care company or directly with AHCA. Senior said AHCA receives about 100 complaints a month. Since August 2013, 22 complaints came from consumers who indicated they were deaf. One complaint cited an interpreter issue.

Amanda Heystek, director of litigation at Disability Rights Florida, a not-for-profit statewide advocacy group, said her group is working with several consumers who claim that their doctors refuse to provide sign language interpreters.

“What we are seeing and hearing is that people with disabilities are facing barriers to access that the system is not adequately accommodating, addressing and removing,” Heystek said.

Sometimes, language is the barrier. For people who became deaf before they learned a language, American Sign Language, which is based on facial expressions and gestures, is their primary means of communication, Dubin said. English is often a second language.

AHCA’s contract for managed care with the Centers for Medicare and Medicaid specifies that written materials be “at the fourth-grade reading level.”

Still, many in the deaf community said managed care forms are not intuitive.

Rolando Fernandez, a 57-year-old unemployed deaf man from Miami, said his limited knowledge of English makes it difficult to communicate with people outside the deaf community.

Fellove agreed that he struggles with the English in his healthcare forms.

“We have a bill and we have no idea what to do with them,” Fellove, 40, said, through an interpreter. “It’s a huge problem that I have gone through, that others in the deaf of this community have gone through.”

Doctors are also supposed to provide interpreter services when needed under the Americans with Disabilities Act. Under managed care, insurance companies now cover interpreter costs. But many in the deaf community are finding some doctors won’t provide the services or don’t know they can defer costs to managed care companies.

“They get told to bring their own, bring friends, pass notes or speak slowly and lip read,” Dubin said.

The managed care companies say doctors in their networks are aware that they must coordinate interpreters for the deaf. Humana Medical Plan, Preferred Medical Plan, Prestige Health Choice, Staywell Health Plan of Florida and United Healthcare of Florida confirmed that their plans, which are offered in Miami-Dade County, included free interpreter services.

Kevin Kearns, CEO of Prestige, said the company conducts routine visits to doctors’ offices in its network to ensure compliance with ADA requirements.

“Some folks are going to have challenges and we understand that,” Kearns said. “We will walk them through it or take the complaint through the phone.”

But after 10 years of fine tuning managed care in Florida, Dubin said these issues should no longer exist.

“Why do they ignore me as a deaf consumer?” Fernandez asked the group assembled last week.

Flicking fists and nodding heads responded.

Follow @MHhealth for health news from South Florida and around the nation.

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

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