ON Oct. 11, 2010, Moise Brutus was in a motorcycle accident. He awoke from a coma three days later as a triple amputee, having lost both legs and his left hand.
In many ways that nightmare scenario was made worse by what followed when Brutus experienced life in the traditional Medicaid system.
“It was really tough,” Brutus said. “At one point, I remember thinking, ‘I can't believe I'm in the United States.' Because it felt like I was getting Third World country care.”
His mother often had to change his bandages. At one point, a bone jutted out of his leg, but he was sent home from the emergency room without treatment. The prosthetics that Medicaid provided kept breaking — at a taxpayer cost of $25,000 to $30,000 apiece — while rehabilitation centers accepting Medicaid couldn't serve a triple-amputee. Brutus fell into deep clinical depression; his weight dropped to 76 pounds.
Fortunately for Brutus, his home state of Florida embarked on a Medicaid reform. It lets private insurance plans compete to provide managed care for Medicaid patients. Customized patient benefits replaced a one-size-fits-all approach. The reform included incentives for providers to take the most challenging patients. It rewarded providers based on health improvement. Florida Medicaid patients soon had a choice of up to 11 private plans.
Brutus was among those benefiting from the pilot project. The difference was dramatic: Coverage provided through privately managed Medicaid plans paid to repair his leg stump. He got prostheses costing around $60,000 apiece — but those were one-time expenses because the prosthetics didn't break. He was sent to a quality rehab facility, where he learned not only to walk again but to ride a bike. He's now a competitive cyclist biking 100 miles per week. And his coverage connected Brutus with support groups helping address the mental health challenges he faced.