Florida set to accept Medicaid expansion money? But at what price?

Section 2001 of the Patient Protection and Affordable Care Act expands eligibility for Medicaid. Florida is one of the twenty-five states opting not to expand Medicaid as President Obama wanted and the Affordable Care Act originally envisaged. The supreme court upheld the personal mandate, the most controversial aspect of the healthcare reform bill, but ruled that states could not be required to expand Medicaid. However, that may all change.

Sarah Boseley writing for The Guardian reports, “Secret conversations are taking place in Florida between healthcare stakeholders and the legislature that will most likely lead to the Republican-controlled state accepting Medicaid expansion money, according to senior figures in the health industry.”

Boseley quotes Patrick Geraghty, President and CEO of Florida Blue, who has been involved in discussions in the state and nationally, “We believe strongly that we ought to be taking that funding. The money should be used to support change and innovation in healthcare systems. For our state it’s $51 [billion] over 10 years. That’s a lot of investment in transformation.”

“States can access the federal funds either if they expand the public Medicaid programme or, as permitted under the legislation, if they come up with an alternative way to fund expanded coverage. To qualify for Medicaid expansion money, however, an alternative system must be granted a waiver by federal authorities. Geraghty said she believed Florida would ‘do the right thing’ and undertake an expansion,” notes Boseley.

Donna Shalala, secretary for health and human services under Bill Clinton and now president of the University of Miami, said, “Governor Rick Scott has already said he would take the Medicaid expansion money for three years. I think the senate has some people that are prepared to play and are prepared to shape some kind of a framework for taking the Medicaid money.”

Whenever a state takes federal funding there are always strings attached and questions about program sustainability. Tarren Bragdon from the Heritage Foundation notes, “The old Rick Scott knew why Medicaid expansion is a dangerous idea: an already bankrupt federal government couldn’t possibly keep its funding promise to cover states’ expansion costs, Medicaid is already failing patients and taxpayers and expanding it would stretch the safety net even more, and the states that previously expanded Medicaid are now facing nightmarish consequences.”

According to Florida Legal Services, Inc., “Currently, the federal government covers approximately 58% of all Medicaid costs in Florida. This percentage is referred to as the federal matching rate or “FMAP.” In contrast to 58% FMAP for the current Medicaid population, the PPACA requires the federal government to cover 100% of costs associated with the newly eligible Medicaid Expansion population from 2014 to 2016. The FMAP for the expansion population gradually tapers down to 90% in 2020 and remains at 90% FMAP thereafter.5 These federal matching rates are mandated by federal law and cannot be altered without an Act of Congress. Further, the federal Centers for Medicare and Medicaid Services have clarified that states can withdraw from covering the expansion population at any time.”

Bragdon states, “Obamacare Medicaid expansion in Florida is projected to cost taxpayers anywhere from $3.7 billion to $19.5 billion annually, FHCP [Florida Health Care Plans] will cost Florida just $237 million a year to provide coverage for an estimated 115,000 uninsured Floridians.” Do the math.

Any expansion of Medicaid will, in the long term, increase the costs to all Florida taxpayers. Proponents of expanding Medicaid in Florida cite “caring for the needy” and a “take the money” to make up for state budget shortfalls. If Medicaid is expanded in Florida it would add one million new enrollees to those already on Medicaid. That would be up to one out of 17 Floridians would become dependent on federal and state Medicaid funds.

So why the big push now? Well, after all 2014 is an election year in Florida and that is potentially one million votes for the party in power, or is it?

Bragdon warns, “When Florida Governor Rick Scott (R) gave Medicaid expansion a metaphorical bear hug last February, he flip-flopped on a years-long record of opposition to the Affordable Care Act (Obamacare). Many argue that the grassroots army he built during his national anti-Obamacare tour in 2009 provided him the jolt of support he needed to win a close race for governor in 2010. But with his expansion flip-flop, it’s unlikely that army will fight passionately for him again.


Health Care Report from the States: Florida Medicaid Expansion

Ignore the rumors: No deals on Medicaid

Reforming Florida’s Medicaid Drug Program

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