— MONTGOMERY, Ala. (AP) — As the Alabama Legislature works to design a bill to help the State Medicaid Agency restructure the way it administers the $5.63 billion program, Jan Carlock worries about some of the proposals.
Carlock is a registered nurse and a quality care manager for the Care Network of East Alabama, a nonprofit agency that provides services to Medicaid recipients. Alabama has four patient care networks that serve as a bridge between sick patients and their doctors. The organization Carlock works with serves about 34,000 people over seven counties.
A bill under consideration could change the present "fee-for-service" basis of Medicaid payments to a for-profit, managed care plan, or a combination of non-profit and for-profit companies. Carlock and others worry that implementing a managed care option could hurt patients.
When she worked for a large managed care corporation in Florida, she said it didn't expand the numbers of patients.
"They have no incentive to expand. If we care for our own neighbors, our dollars stay here in our communities," she said. "They can enroll elderly and sick people who do not understand what managed care is and they will not use the services. The company gets paid even if they do not provide medical care."
Carlock gave an example of a patient, an elderly man who was not identified due to privacy laws. She said he can't read. He is poor, lives alone and suffers from severe hypertension. He needs daily medication but had to guess his dosage, if he remembered at all. He had been going to the ER when he got too sick, but a nurse from the Care Network taught him how to divide his medications into daily containers. She stops by weekly to help him. That monitoring has saved the state money and improved the man's health.