Medicaid Archives - Florida Politics

States that elected Donald Trump, including Florida, most affected by his health care decision

President Donald Trump‘s decision to end a provision of the Affordable Care Act that was benefiting roughly 6 million Americans helps fulfill a campaign promise, but it also risks harming some of the very people who helped him win the presidency.

Nearly 70 percent of those benefiting from the so-called cost-sharing subsidies live in states Trump won last November, according to an analysis by The Associated Press.

The subsidies are paid to insurers by the federal government to help lower consumers’ deductibles and co-pays. People who benefit will continue receiving the discounts because insurers are obligated by law to provide them. But to make up for the lost federal funding, health insurers will have to raise premiums substantially, potentially putting coverage out of reach for many consumers.

Some insurers may decide to bail out of markets altogether.

“I woke up, really, in horror,” said Alice Thompson, 62, an environmental consultant from the Milwaukee area who purchases insurance on Wisconsin’s federally run health insurance exchange.

Thompson, who spoke with reporters on a call organized by a health care advocacy group, said she expects to pay 30 percent to 50 percent more per year for her monthly premium, potentially more than her mortgage payment. Officials in Wisconsin, a state that went for a Republican presidential candidate for the first time in decades last fall, assumed the federal subsidy would end when they approved premium rate increases averaging 36 percent for the coming year.

An estimated 4 million people were benefiting from the cost-sharing payments in the 30 states Trump carried, according to an analysis of 2017 enrollment data from the U.S. Centers for Medicare and Medicaid Services. Of the 10 states with the highest percentage of consumers benefiting from cost-sharing, all but one — Massachusetts — went for Trump.

Kentucky embraced former President Barack Obama‘s Affordable Care Act under its last governor, a Democrat, and posted some of the largest gains in getting its residents insured. Its new governor, a Republican, favors the GOP stance to replace it with something else.

Roughly half of the estimated 71,000 Kentuckians buying health insurance on the federal exchange were benefiting from the cost-sharing subsidies Trump just ended. Despite the gains from Obama’s law, the state went for Trump last fall even as he vowed to repeal it.

Consumers such as Marsha Clark fear what will happen in the years ahead, as insurers raise premiums on everyone to make up for the end of the federal money that helped lower deductibles and co-pays.

“I’m stressed out about the insurance, stressed out about the overall economy, and I’m very stressed out about our president,” said Clark, a 61-year-old real estate broker who lives in a small town about an hour’s drive south of Louisville. She pays $1,108 a month for health insurance purchased on the exchange.

While she earns too much to benefit from the cost-sharing subsidy, she is worried that monthly premiums will rise so high in the future that it will make insurance unaffordable.

Sherry Riggs has a similar fear. The Fort Pierce, Florida, barber benefits from the deductible and co-pay discounts, as do more than 1 million other Floridians, the highest number of cost-sharing beneficiaries of any state.

She had bypass surgery following a heart attack last year and pays just $10 a visit to see her cardiologist and only a few dollars for the medications she takes twice a day.

Her monthly premium is heavily subsidized by the federal government, but she worries about the cost soaring in the future. Florida, another state that swung for Trump, has approved rate increases averaging 45 percent.

“Probably for some people it would be a death sentence,” she said. “I think it’s kind of a tragic decision on the president’s part. It scares me because I don’t think I’ll be able to afford it next year.”

Rates already were rising in the immediate aftermath of Trump’s decision. Insurance regulators in Arkansas, another state that went for Trump, approved premium increases on Friday ranging from 14 percent to nearly 25 percent for plans offered through the insurance marketplace. Had federal cost-sharing been retained, the premiums would have risen by no more than 10 percent.

In Mississippi, another state Trump won, an estimated 80 percent of consumers who buy coverage on the insurance exchange benefit from the deductible and co-pay discounts, the highest percentage of any state. Premiums there will increase by 47 percent next year, after regulators assumed Trump would end the cost-sharing payments.

The National Association of Insurance Commissioners has estimated the loss of the subsidies would result in a 12 percent to 15 percent increase in premiums, while the nonpartisan Congressional Budget Office has put the figure at 20 percent. Experts say the political instability over Trump’s effort to undermine Obama’s health care law could prompt more insurers to leave markets, reducing competition and driving up prices.

In announcing his decision, Trump argued the subsidies were payouts to insurance companies, and the government could not legally continue to make them. The subsidies have been the subject of an ongoing legal battle because the health care law failed to include a congressional appropriation, which is required before federal money can be spent.

The subsidies will cost about $7 billion this year.

Many Republicans praised Trump’s action, saying Obama’s law has led to a spike in insurance costs for those who have to buy policies on the individual market.

Among them is Republican Rep. Andy Biggs of Arizona, a state Trump won. An estimated 78,000 Arizonans were benefiting from the federal subsidies for deductibles and co-pays.

“While his actions do not take the place of real legislative repeal and revitalization of free-market health care, he is doing everything possible to save Americans from crippling health care costs and decreasing quality of care,” Biggs said.

Republished with permission of The Associated Press.

‘LIP’ money falls short of initial estimates

At the height of a budget showdown earlier this year, Gov. Rick Scott boasted that his friendship with President Donald Trump‘s administration would result in Florida getting $1.5 billion to help the state’s hospitals.

But months later, the final amount will be considerably smaller, a top state Medicaid official said Wednesday. Instead the state will have about $790.4 million in supplemental Medicaid funds to spend this year.

Beth Kidder, a deputy secretary at the state Agency for Health Care Administration, told the Senate Health and Human Services Appropriations Subcommittee that the agency has $303 million in funding commitments from counties to help fund the Low-Income Pool. The money will be used to draw down $487 million in federal Medicaid dollars bringing the total available to just more than $790 million for the supplemental program widely known as LIP.

“The $1.5 billion is not $1.5 billion,” Senate Health and Human Services Appropriations Chairwoman Anitere Flores, a Miami Republican, said.

Kidder told the panel that the size of the Low-Income Pool has always been contingent on the receipt of matching local dollars to fund it. While the state in the past has been able to fully fund the program, the federal government has changed its expectations on how money can be spent. For instance, money can no longer be used to help offset losses hospitals incur while treating Medicaid patients. Under the new rules, only charity care can be considered for reimbursement.

The restrictions, Kidder said have made it “onerous and difficult for funders” to agree to provide the required local matching dollars. She also noted that the state didn’t get final approval of what is known as a Medicaid 1115 waiver and accompanying special terms and conditions until August, after local governments had already prepared budgets. The Medicaid 1115 waiver gives the state the authority to operate its mandatory Medicaid managed-care program as well as the LIP program.

Kidder tried to remain optimistic, though. She told the committee that the $790.4 million in LIP funds for fiscal year 2017-2018 is more than the $590 million Florida had for the program last year. Additionally, she reminded lawmakers that the Trump administration agreed to keep available a $1.5 billion LIP program for the next five years.

“It’s out there, it’s a target,” she said of the $1.5 billion annual commitment.

Under the approved waiver, three groups of providers can tap into LIP funds: hospitals, medical school faculty and federally qualified health centers. All of them must agree to certain requirements to get the money. For instance, hospitals must agree to sign contracts with at least half of the standard Medicaid health plans that operate in their regions.

Meanwhile, the Agency for Health Care Administration posted details on how it plans to distribute the $790 million in LIP funding. More than $654 million is being directed to 204 hospitals, $85 million is being directed to eight medical faculty teaching practices and another $50 million is allocated to federally qualified health centers.

The federally qualified health centers, though, say they have problems with a provision in the Medicaid 1115 waiver’s special terms and conditions that requires all reimbursements to the clinics to be made by managed-care organizations, rather than the state paying bills directly.

Kidder told lawmakers that the agency has met with the federally qualified health centers to discuss the concerns, including a meeting Wednesday.

Florida Association of Community Health Centers President Andy Behrman told senators that the Wednesday meeting with state officials was a “good move forward” and that there may be a way to solve some of his members’ concerns.

He said the clinics don’t want to walk away from $50 million but that they need to be protected.

The state has asked counties contributing matching dollars to the LIP program to send signed letters of agreement to the state by Nov. 15 and to send the funds to the state the following month.

After the state receives the funding, Kidder said, it will submit a proposed budget amendment to legislative leaders for approval. The budget amendment will include a 2017-2018 LIP distribution model that shows the government entities that contributed the funds as well as the funding distribution by provider.

The amendment will be approved within 14 days of submission unless the chair and vice chair of the Joint Legislative Budget Commission or the Senate president and speaker of the House of Representatives oppose the amendment in writing.

Republished with permission of the News Service of Florida.

AHCA eyes hospitals for budget cuts

Gov. Rick Scott‘s administration continues to target hospitals for potential Medicaid spending reductions in the coming year.

The Agency for Health Care Administration’s top four proposed budget cuts for the Legislature to consider during the 2018 session would reduce Medicaid payments to hospitals by nearly $1 billion. Those reductions would be on top of nearly $500 million in recurring cuts made to hospitals during the 2017 session.

“It would be devastating, for goodness sakes,” said Jan Gorrie, a hospital lobbyist and managing partner of the Tampa office of Ballard Partners. “I’m surprised to see the magnitude of the cut. It’s mind-blowing. It’s like, whoa.”

In addition to a list of proposed reductions for the Legislature to consider, AHCA also submitted its proposed budget requests for the upcoming year. It includes a request for an additional $66 million to cover a deficit in the Children’s Medical Services managed-care plan for the current year. The deficit is a result of lower enrollment in the Medicaid specialty plan than anticipated.

The agency also is requesting $925,000 for analytics of data submitted to what is known as the all-payer claims database. And $700,000 so the agency can implement a new Medicaid prepaid dental health program for children and adults.

Meanwhile, the agency’s top recommendation to save money is to alter a current policy that provides retroactive Medicaid eligibility for the 90 days prior to a beneficiary’s application being submitted. AHCA is recommending that the state trim retroactive eligibility to 30 days.

During the retroactive period, the state picks up the health care bills that accrued in the three months including paying for “uncoordinated and potentially inappropriate utilization of medical services,” budget documents note.

Trimming retroactive eligibility from 90 days to 30 days would reduce Medicaid spending by $98.4 million according to the agency’s budget documents. Hospitals would lose $58.3 million if the Legislature were to agree to the change.

Agencies annually compile proposed reduction lists as part of the budget process. The question is whether or not the Legislature will, in fact, target the areas that have been identified by the agencies in what is expected to be a tight budget year.

A financial outlook prepared by state economists in September said Florida’s surplus may be as small as $52 million, but those projections did not include the state’s costs responding to Hurricane Irma.

AHCA compiled a list of six proposed spending reductions and assigned each proposal a priority number. The agency’s second-highest priority is reducing the amount Medicaid spends on reimbursing hospitals by $318 million in total funds by eliminating automatic rate enhancements.

Its third recommendation is restricting participation in the Medicaid “Medically Needy” program to about 1,600 pregnant women and children. The move would eliminate coverage for about 27,000 people currently covered under the program. The program provides Medicaid access to people who don’t qualify for Medicaid because of their income levels.

The fourth recommendation is eliminating an optional Medicaid program that provides coverage to 51,057 aged, blind and disabled people with incomes above what’s allowable for Social Security income but below 88 percent of the federal poverty level. Eliminating the “Meds AD” program would reduce total spending by $558 million.

The Medically Needy program and the Meds AD program have been offered up in the past by the agency as potential ways to save money, but the Legislature has not chosen to reduce them.

AHCA’s fifth recommendation is to reduce $135,150,336 in the Home and Community Based Services Waiver funding. It is “double budgeted” according to budget documents.

Lastly, the Legislature could reduce spending in Medicaid HMOs by 5.16 percent, or nearly $475 million. To achieve that level of reduction, though, the state would have to eliminate some of the services that currently are covered under the Medicaid managed care program, which would require federal approval.

Republished with permission of the News Service of Florida.

Telehealth panel eyes insurance, licensing

To increase the use of telehealth in Florida, a panel is recommending that insurance companies be required to reimburse health care providers for telehealth services and that the Legislature authorize participation in interstate “compacts” that make it easier for doctors and other providers to be licensed in a variety of states.

The Telehealth Advisory Council held a two-hour-plus teleconference Tuesday, with members reviewing a draft copy of a 32-page report that will be sent to the governor and Legislature later this month.

Agency for Health Care Administration Secretary Justin Senior, the chairman of the advisory council, said a copy of the report would be posted publicly and that another meeting will held before the panel votes on the final version.

“I really appreciate all the work that has gone into this. I really think it’s coming together nicely,” Senior told members of the council.

Telehealth, at least in part, involves using the internet and other technology to provide services to patients remotely. The Legislature for years grappled with telehealth and how it should best be used and regulated. In 2016, lawmakers passed a bill creating the advisory council and directed it to survey the current level of telehealth participation in the state, identify obstacles and make recommendations on how those obstacles can be eliminated.

Recommendations in the report run the gamut, from making clear that a practitioner/patient relationship can be established through telehealth to providing a definition for telehealth.

Perhaps the most controversial recommendation, though, is that the Legislature require insurance companies to reimburse health care providers for telehealth services as though the care were provided face-to-face.

Moreover, the draft report also recommends that insurance companies cover services provided via telehealth if the same services are covered for in-person visits.

The advisory board recommendation applies to commercial insurance coverage only. The report recommends, however, that the state support changes being considered by Congress that would make Medicare coverage of telehealth services less restrictive.

With regard to Medicaid, the advisory council is recommending that the state amend its Medicaid rules and allow reimbursement to providers for more telehealth services. Currently, Medicaid rules allow for reimbursement of live video conferencing only.

Advisory council member and Leon County EMS provider Kim Landry told The News Service of Florida Monday that the recommended mandates on insurance companies should go a long way to increasing access to telehealth services.

“Reimbursement has been an issue,” he said noting that he doesn’t expect every provider to gravitate toward telehealth but that the promise of reimbursement will help sway some physicians.

As of September, 34  states and the District of Columbia had established health-insurance parity laws to address gaps in coverage for telehealth services, according to the draft report. But only three of the states with telehealth parity laws explicitly mandate that the reimbursement for telehealth services be the same as for in-person care.

The advisory council worked with the Office of Insurance Regulation, the Department of Health and the Agency for Health Care Administration in polling insurance companies, facilities and providers about telehealth.

The findings showed that only 6 percent of practitioners in Florida reported using telehealth, which was below the national average of 16 percent.

Those who did offer telehealth services were recent converts, with 55 percent reporting doing so for the first time in the last year.

The poll also showed hospitals in Florida lagged behind their peers nationally in the use of telehealth. While 45 percent of hospitals responding to the Florida survey reported using telehealth, that was less than the 52 percent of hospitals (with another 10 percent in the process) in a 2013 national poll.

Results of the Florida survey showed that for health care practitioners, the top barriers for telehealth were financial. Practitioners were concerned about the required investments, adequate reimbursement for services and a financial return.

In addition to tackling reimbursement, the advisory council also weighed in on licensure requirements, recommending that “health care practitioners be licensed in Florida prior to being allowed to provide care to a patient in Florida.”

To make the licensure process easier, the council is recommending that the Legislature authorize Florida to participate in multi-state practitioner licensure compacts so long as the eligibility requirements for licensure equal or exceed the state’s existing requirements.

The advisory council also is recommending that, similar to the boards of medicine and osteopathic medicine, the various health care regulatory boards and councils be given specific authority to develop rules necessary to implement telehealth.

Republished with permission of the News Service of Florida.

Nursing home challenges moratorium, Medicaid cutoff

A Broward County nursing home has filed a lawsuit seeking to block Gov. Rick Scott‘s administration from cutting off Medicaid payments and carrying out a moratorium on patient admissions after the deaths of nine of the facility’s residents following Hurricane Irma.

The Rehabilitation Center at Hollywood Hills filed the lawsuit late Tuesday in Leon County circuit court, seeking injunctions against orders issued last week by the state Agency for Health Care Administration. Those orders suspended the facility from the Medicaid program and placed a moratorium on admissions.

The lawsuit came as authorities announced Tuesday night that a ninth nursing-home resident had died – and as debate continued raging about whether the facility had acted properly after Hurricane Irma knocked out its air conditioning system. Eight of the residents died Sept. 13, three days after the system went down. Other residents were evacuated.

In the lawsuit, attorneys for The Rehabilitation Center at Hollywood Hills argue, in part, that the facility followed emergency-preparedness plans in the way it handled the air conditioning outage. Also, the lawsuit alleges that the Scott administration violated the facility’s due-process rights by issuing the immediate admissions moratorium and Medicaid suspension.

“With the stroke of a pen, AHCA (the Agency for Health Care Administration) has effectively shut down Hollywood Hills as a nursing home provider in Broward County,” the lawsuit said. “These illegal and improper administrative orders took effect immediately and without any opportunity for the facility to defend itself against unfounded allegations.”

In issuing the orders last week, AHCA alleged that the facility presented a threat to public health, safety or welfare, with one of the orders saying that “deficient practices exist presently and will more likely than not continue to exist if the agency does not act promptly.”

Scott also has repeatedly criticized the facility, contending that it did not adequately protect residents after the air conditioning system went out. The nursing home used fans and devices known as “spot coolers” while the air conditioning system was out.

“The more we learn about this, the more concerning this tragedy is,” Scott said in a statement Tuesday night. “Through the investigation, we need to understand why the facility made the decision to put patients in danger, whether they were adequately staffed, where they placed cooling devices and how often they checked in on their patients. The families of those who trusted The Rehabilitation Center at Hollywood Hills deserve answers and those responsible for this horrific behavior should be prosecuted to the fullest extent of the law.”

The deaths of the nursing-home residents have drawn national attention and a criminal investigation. The Hollywood Police Department Tuesday night listed the ninth resident who died as Carlos Canal, 93.

Throughout the past week, the Scott administration and the nursing home have sparred about whether facility officials took adequate steps after Hurricane Irma knocked out a transformer for the air conditioning system. That back-and-forth has included questions about communications between facility and state officials about the lack of air conditioning, communications between the facility and Florida Power & Light and whether nursing officials should have called 911 earlier.

Scott’s office Tuesday night released a timeline of events, while the lawsuit includes another timeline provided by the nursing home.

While the Scott administration and the nursing home reach different conclusions about whether the facility handled the situation properly, both timelines reflect a series of phone calls and messages between representatives of the nursing home and the state on Sept. 11 and Sept. 12. Scott moved quickly last week to place a moratorium on admissions to the nursing home and to suspend the facility from Medicaid — a crucial source of funding for many nursing facilities. Also, Scott directed state officials to issue emergency rules aimed at requiring nursing homes and assisted-living facilities to have generators that would power air conditioning systems.

Scott moved quickly last week to place a moratorium on admissions to the nursing home and to suspend the facility from Medicaid — a crucial source of funding for many nursing facilities. Also, Scott directed state officials to issue emergency rules aimed at requiring nursing homes and assisted-living facilities to have generators that would power air conditioning systems.

In the lawsuit, The Rehabilitation at Hollywood Hills pointed to the lack of such a requirement in arguing against the admissions moratorium and the Medicaid suspension.

“Hollywood Hills is currently in no different position than any other nursing home in the state with respect to the requirement of emergency generator power for central AC units,” the lawsuit said. “Put simply, the lack of an emergency generator backup is the current norm in nursing homes throughout the state and does not constitute an emergency crisis for Hollywood Hills that differs from any other nursing home in Florida that is compliant with current statutes and rules.”

Republished with permission of the News Service of Florida.

Andrew Behrman: Burdensome requirement threatens health centers’ ability to offer care

With governments wrestling with the ever-increasing costs of health care, it is critical for all of us to consider ways Florida can save money while still serving those with limited access to care. This is why we should all support the mission of Florida’s 49 Federally Qualified Health Centers (FQHCs), which serve over 1.4 million low-income, uninsured patients and save the state hundreds of millions of dollars that otherwise would be needed for costly emergency room services.

Unfortunately, the ability for our centers to continue to provide critical services to even more uninsured patients is in jeopardy because of an unnecessary bureaucratic rule that would expand significant inefficiencies in the state’s existing reimbursement system.

Earlier this month the Trump administration approved a Florida Medicaid waiver increasing Low Income Pool (LIP) funding to $1.5 billion. A relatively small portion of this, $50 million per year for the next five years, was specifically designated to help FQHCs cover the significant costs of uncompensated care for low-income or uninsured patients. This funding is absolutely crucial for our centers’ ability to serve vulnerable communities. The Florida Agency for Health Care Administration’s proposed reimbursement system would create unwarranted administrative hoops and delay our ability to serve these Floridians.

Our centers are a key part of Florida’s health care safety net. We operate in every Florida county, with over 460 locations across the state, and by law cannot turn away any patient who needs our services. Our doctors treat patients who desperately need access to care but cannot afford it. More than one-third of our patients are uninsured, and another half depend on Medicaid or Medicare.

By seeing these patients in our centers, we avoid the need for visits to hospital emergency rooms — saving the state hundreds of millions of dollars each year. Despite this tremendous return on investment, the state has dramatically cut our funding to a mere $9 million last year and then, to make matters worse, reduced it further to $6 million in the current fiscal year.

The recently approved LIP funding is absolutely essential for us to be able to continue operations and serve Florida’s communities efficiently. But forcing all reimbursements to go through managed care organizations, rather than state paying bills directly, will lead to delay and inefficiency making it difficult for our centers to operate.

Since our centers are required to see every patient who comes in the door, they will continue to do so for as long as they possibly can. However, it is fair to be concerned about the potentially dire consequences. Many community health centers are struggling now to make ends meet in the face of delayed and disputed reimbursements, and we fear this will only worsen if the managed care organizations are given even more authority over payment decisions.

The money is available, and our centers are ready to meet the ever-growing need for their services. If freed from burdensome requirements on the new funds, our centers can provide additional medical care, which in turn will lead to even greater savings for the state. AHCA must allow our centers to access the funding, without unnecessary roadblocks that delay the ability to provide the care our communities so desperately need.

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Andrew Behrman is president and CEO of the Florida Association of Community Health Centers.

 

Amy Mercado: The never-ending battle against higher premiums

We recently learned that if the Donald Trump administration pulls Obamacare subsidies, premiums will jump 20 percent on the most popular coverage, according to the nonpartisan Congressional Budget Office. This would be very bad news for Floridians who are already struggling with the rising costs of health care.

Our state has led the nation in Obamacare sign ups with more than 1.6 million enrolled in 2017, up from 1.1 million the prior year. This is due, in some part, to the refusal of leadership in Tallahassee to expand Medicaid that left up to 1 million Floridians without access to the health care coverage they need to live and work.

If there is any doubt about the dire need for affordable health care coverage, 45 of 50 states have fewer uninsured people than Florida. We simply can’t afford any premium increases.

That’s why it’s also important to once again delay the looming Health Insurance Tax.

This Health Insurance Tax, also known as the “HIT tax,” was previously delayed by Congress for the current year. The delay received bipartisan support, with 400 members of Congress voting in favor of the delay, and it was signed into law by President Barack Obama.

The Health Insurance Tax is estimated to increase premiums on certain policies by about 3 percent in January 2018. Seniors enrolled in Medicare Advantage and small-business owners, their employees and their families will also have to pay more out of pocket.

And the state Medicaid budget will be squeezed even more than it is already — especially bad timing considering the Florida Legislature just cut funding for care provided to Medicaid patients.

As a working mom, businesswoman and former health care worker, I know that every penny counts. When you can’t afford coverage, you can’t afford to get sick.

I also know these numbers don’t tell the whole story.

When we talk about health care here in Central Florida or anywhere in the country, we need to think about our friends, our family and our neighbors — real people trying to make ends meet.

That’s who pays higher premium costs due to the actions or inactions of our lawmakers.

When I go back to Tallahassee for committee weeks and the 2018 Legislative Session, I promise to continue fighting for better access to the health care coverage Floridians deserve.

I hope that our federal lawmakers, Sens. Marco Rubio and Bill Nelson, and our local Congressional Delegation, including Reps. Stephanie Murphy, Darren Soto and Val Demings will support continued Obamacare subsidies and also delay the Health Insurance Tax for 2018 to keep premiums from rising on small businesses, seniors and our state budget.

Floridians can’t afford any premium increases.

We need more affordable coverage, not less.

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Amy Mercado represents District 48 in the Florida House of Representatives.

CNN reports political favors led to 13K kids losing coverage; Chris King calls for probe

Democratic gubernatorial candidate Chris King is calling for an independent investigation after CNN report Friday alleging the Florida Department of Health used faulty processes and political motives to kick 13,000 chronically sick children out of the state’s Children’s Medical Services program.

“I’m calling for an independent investigation into the Florida Department of Health and the administrative actions that led to this systematic decision to rip CMS health coverage away from more than 13,000 sick children and what influenced this decision,” King said in a news release issued by his campaign.

The Florida Department of Health responded Friday by contending the cable news network used misunderstanding and outdated information to inaccurately characterize the program, and that the claims that politics  played any role “is 100 percent false.”

“CNN’s reporting demonstrates a misunderstanding of Florida’s Medicaid system, the health insurance industry and the ethical standards of the State of Florida,” the DoH statement said.

Yet the department’s response largely defends what has happened since 2015, not responding much to what happened in 2015. What appears to not be at issue is that in 2015 Florida removed more than 13,000 children from the Children’s Medical Services program, a state-run Medicaid program set up for chronically-sick children, and referred them to other, private, Medicaid insurers.

The CNN report contends that the CMS program was nationally respected and designed to handle the sickest of kids, but claims those transferred off included many children with serious health problems including birth defects, heart disease, diabetes and blindness. It network reports that many of them were unable to find services under the new insurance plans which did not specialize in severe and chronically-sick children, which and which were not accepted by certain pediatric specialists.

CNN then cited experts and researchers in children’s health programs who said the data analysis, screening tools, and processes the Florida Department of Health used to decide which children would be dropped from CMS were deeply flawed, “completely invalid” and “a perversion of science,” in two comments.

The report then cites experts, including Dr. Louis St. Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics, who allege the children were switched to the private Medicaid insurers to reward Republican contributors. CNN also breaks down campaign contributions from the private insurance carriers to the Republican Party of Florida and other Republican political committees.

“Local and national experts in the medical field have expressed concern that this may have been done for political reasons, which, if true, would be deeply troubling,” King stated, first on Facebook, and then in a news release from his campaign. “The bottom line is that these children went without critical and oftentimes life-saving medical treatments and services because the state of Florida dropped them from CMS.”

King, a Winter Park developer, faces former U.S. Rep. Gwen Graham of Tallahasse and Tallahassee Mayor Andrew Gillum for the Democratic nomination to run for governor in 2018. Agriculture Commissioner Adam Putnam of Bartow and state Sen. Jack Latvala of Clearwater are running for the Republicans.

The Department of Health addressed CNN’s allegations one-by-one, dismissing them all. Yet the DoH’s overriding concern is the argument that the processes and tools used in 2015 were discarded and in 2016 new and better tools were used. The department said all of the families of children removed from the program in 2015 were sent letters encouraging them to re-screen their kids for possible re-enrollment in CMS.

The department argued there would be no benefit to the private insurers to pick up the chronically sick children, so it clearly was no reward for anything.

“According to the state’s Medicaid agency [Agency for Health Care Administration,] it is not true that health insurers benefit from having higher risk patients on their plans,” the DoH statement said. “This is a claim CNN makes and then contradicts with the fact that sick children are costlier for insurance companies because of the care they need. There was no financial impact or plan profit from any change. Plans do not receive an individual rate for each enrollee, but rather one overall rate for the entire plan.”

At least since early 2016, the screening tools CNN reported on, which were used for about two years, were no longer in use, the department stated.

“Beginning on January 11, 2016, the department resumed clinical eligibility screening using the process defined by Rule 64C-2.002, Florida Administrative Code. The process includes a two-part approach to clinical eligibility screening – a physician-based, auto-eligibility process using diagnostic codes for chronic and serious conditions and a parent-based survey to ensure that all financially eligible children with special health care needs are given the option to enroll in the CMS Plan,” the DoH reported. “At any time, a parent or physician can request that a child be screened or rescreened for the CMS plan – a fact CNN omits from their story.”

And finally, the department contended, “Since the time CNN is speaking of, more than two years ago, there have been multiple changes in department and CMS Plan leadership.”

Florida’s cost for losing lawsuits keeps growing

Florida’s price tag for losing legal battles – which has included courtroom fights over drug testing, voting rights and gay marriage – continues to grow under Gov. Rick Scott.

Scott recently agreed to pay $1.1 million to cover the legal bills of physicians and medical organizations in their successful challenge of a law that restricted doctors’ ability to talk to patients about guns. The law had been pushed through the Florida Legislature at the urging of the National Rifle Association.

In early July, the state also agreed to a $2 million payment that will go to lawyers who sued on behalf of disabled inmates.

A review of records by The Associated Press shows that since Scott took office in 2011 the state has paid at least $19 million to cover expenses and fees for lawyers who have sued the state. Many of those lawsuits took aim at policies put in place by Scott and the Republican-controlled Legislature.

The Scott administration has defended the legal expenses in the past, saying the governor will “vigorously defend” Florida’s laws.

In February a federal appeals court ruled that Florida doctors can talk to patients about gun safety, declaring a law aimed at restricting such discussions a violation of the First Amendment’s right to free speech. The state did not appeal the decision and in late June reached a settlement to pay $1.1 million for attorney fees and costs.

One of the firms involved in the lawsuit – Ropes & Gray – announced it would donate $100,000 of its fee award to the Brady Center to Prevent Gun Violence.

“This award is a message to states to think twice before enacting or defending laws that put lives at risk just to boost the gun industry’s bottom line,” said Dan Gross, president of the Brady Center to Prevent Gun Violence, in a statement.

John Tupps, a spokesman for Scott, defended the state’s fight over the law. He said the governor was a “strong supporter” of the 2nd Amendment and that he signed the bill “after it was approved by a large, bipartisan majority in the Florida Legislature.”

Earlier this month, the state agreed to pay $2 million to cover the fees and costs for groups that sued the state in 2016 over its treatment of inmates with hearing, vision and mobility disabilities.

Randall Berg with the Florida Justice Institute said the money will go to reimbursing the institute, Disability Rights Florida, Jacksonville Area Legal Aid and the well-known personal injury law firm Morgan & Morgan. John Morgan is a frequent Democratic donor and has been speculating about running for governor next year.

In the last six years, the state has agreed to pay attorney fees of lawyers who have sued the state over everything from employee discrimination to drug testing of welfare recipients.

The total includes $12 million paid to attorneys who represented pediatricians in a more than 10-year legal battle over whether Florida violated federal mandates by failing to deliver critical health services to 2 million children on Medicaid.

The state also paid more than $800,000 to lawyers working for the American Civil Liberties Union and nearly $513,000 to lawyers who defeated a state law targeting businesses doing business in Cuba.

An AP review found that between 2011 and early 2017 that Florida had spent more than $237 million on outside lawyers hired to defend the state.

Republished with permission of The Associated Press.

Rick Scott: DC needs to start rewarding efficiency, not inefficiency

Ed. Note: Gov. Rick Scott‘s office sent the following op-ed regarding “the national healthcare debate.”


I recently traveled to D.C. to fight for Florida as the U.S. Senate debated repealing and replacing Obamacare. For far too long, D.C. politicians have focused only on the grand bargain of repealing and replacing Obamacare, ignoring the opportunity to make incremental changes to get rid of the taxes and mandates and roll back the federal welfare state. 

For decades, the federal government has been willing to spend more than it takes in. We all know this is not sustainable, leaving debt for our children and grandchildren – more than $19 trillion in debt and counting. The inaction we’ve seen on repealing Obamacare shows that hasn’t changed.

Throughout this healthcare debate, a lot of people have been advocating for bigger government, and not a lot of people have been advocating for taxpayers. I will always advocate for Florida’s hardworking taxpayers.

While a new bill has been introduced this week, it has taken far too long to get rid of the disaster of Obamacare, and I fear the politicians in Washington will never find common ground on this critical topic. There is absolutely no question that Obamacare must be repealed immediately so Americans can actually afford to purchase health insurance.

To lower costs, fundamental reform to the Medicaid program is needed. Obamacare encouraged a massive expansion of Medicaid to cover able-bodied, working-aged adults, even as 600,000 elderly Americans and individuals with disabilities nationwide sit on waiting lists to access services through this program.  

States like Florida that have run increasingly efficient Medicaid programs, and have not expanded Medicaid, must be rewarded and treated fairly under any bill. What’s concerning is that under the most recently proposed Senate bill, tax and spend states like New York will continue to be rewarded for running an inefficient Medicaid program.

Long before the Obamacare debate, New York ran a terribly inefficient Medicaid program for decades which ran up their state’s deficit and hindered their economy. Florida is the exact opposite. We have been efficient with our dollars while providing quality care to those who truly need Medicaid. 

As a reward for its fiscal irresponsibility, for every dollar New York pays in federal income taxes, they receive a quarter back from the federal government for Medicaid. In comparison, Florida only receives 16 cents for every tax dollar that is sent to Washington. Current Congressional bills lock in past federal spending, which would make this inequity permanent.

That makes absolutely no sense. If Florida is going to get a smaller rate of return on its federal taxes, shouldn’t our federal taxes be cut? New York, with fewer residents than Florida, receives more than $33 billion per year for Medicaid while Florida receives less than $15 billion.

How is permanently locking in these spending levels fair to Floridians when New York has been terribly inefficient with their taxpayers’ dollars? The federal government should cut income taxes for Floridians by 30 percent. This would put our share of federal Medicaid funding as a percentage of taxes paid on par with New York. This reduction would save Floridians thousands each year.

The federal government must start rewarding efficient states like Florida and stop rewarding inefficient states. Our taxpayers deserve nothing less. 

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