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The effects of the massive Medicaid system overhaul that Florida legislators passed in 2011 in the name of cost reductions and improved patient care and that Gov. Rick Scott signed into law are being felt locally, with the brunt of the impact falling on the poor, elderly and frail. Or so Dianne Fincham, executive director of the Jefferson County Senior Citizens Center, told the Monticello City Council recently. Addressing the council on Tuesday evening, July 8, Fincham offered that the Statewide Medicaid Managed Care (SMMC) program that the Legislature created in 2011 was beginning to hit home, resulting in the loss of the center’s case management contracts. “Right off the top, our center lost $108,000,” Fincham said. “That’s $9,000 a month, so we’ve had to cut back on staff and buses. We’re just trying to keep our doors open.” The center’s total budget, she said, was $200,000. Meaning that the $108,000 represented more than a 50-percent loss, making the operation practically unsustainable. Insofar as those senior citizens who had previously depended on the center for living assistance services such as prescription drugs, doctors’ visits and hospital stays, a private insurance company was now managing these services, she said. Meaning that residents here wanting to access the services had to call an 800 number, Fincham said, adding that often the people at the other end weren’t disposed to be particularly helpful or sympathetic. “They don’t care,” she said. “It’s all about saving money.” Fincham told the council that it behooved the center to make up the lost funding. “These clients rely on us,” she said. “Some of them only see someone when our staff goes out to see them. The managed care companies don’t care.” She said it was important that the center keep its doors open, if only to provide a place where the elderly could come to find a semblance of community and companionship. “If we close the doors, these people won’t have anywhere to go,” Fincham said, noting that the manage care payments had been a critical component of the center’s operating funds. “The managed care is what paid for us to keep the doors open,” Fincham said. “With it gone, we can’t do it.” She said the center continued to receive federal grants and other funding but it wasn’t enough; other funding sources had to be found. “The center is a valuable resource for this community,” Fincham said, underscoring that often it was all that kept the elderly from going into nursing homes. Tom Love, a member of the Senior Citizens Center Board of Directors, addressed the council next. Love said he was shocked by what was occurring at the center, in terms of its lost funding. He took a different tact, however. Although it was true that the center was known for the service it provided to the poor, frail and elderly, he believed that the current situation presented an opportunity to go beyond what the center has traditionally offered, Love said. “The actual core mission of the center is to provide opportunities for people 60 and older, not only the poor, frail and elderly,” Love said. “These services can be provided on a fee-basis for such things as personal care. We have a good infrastructure for providing services to everyone. We need to find ways to add more people to the system. We’re trying to make a more broadly based center for the community.” All the same, Fincham reiterated that any funding that the city could see fit to give the center to help defray its costs would be appreciated. She also said that she planned to carry the same message to the Jefferson County Commission. The SMMC, which lawmakers approved in 2011 after more than a year of wrangling, shifted hundreds of thousands of poor and elderly Medicaid beneficiaries into HMOs and other types of managed care plans. The change was intended to hold down spiraling costs and improve the fragmented system of care. The overhaul required managed-care enrollment by late 2013 for seniors who needed long-term care and by late 2014 for the broader Medicaid population, such as women and children. The program carved the state into regions, with managed-care plans competing for contracts in each region. Medicaid is the federal/state program for the poor and disabled. State leaders’ goal is eventually to move Florida’s estimated 3 million Medicaid recipients into privately managed health plans, holding it will lower costs and maintain or improve the quality of care.