Medicaid Archives - Page 3 of 33 - Florida Politics

Safety net hospital executives travel to Washington in search of money

Representatives of hospitals that provide a lot of charity care in Florida were headed to Washington Monday to urge federal health care officials and members of Congress to give them more money and freedom to spend it.

Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, said members hope the Trump administration will prove friendlier than former President Obama, who trimmed Washington’s Low Income Pool financing for charity care from $2.2 billion to $608 million during the past three years.

That harmed “hospitals’ ability to care for all residents, not just those that cannot pay for their care. Now is the time to correct that injustice and ensure that Florida receives its fair share of federal funding to help cover the costs of caring for the poor and uninsured,” Carvalho said in a written statement.

Texas gets 500 percent more than Florida, he said, and California gets 20 times more.

“While we appreciate Gov. Rick Scott recommending the continuation of today’s $608 million in LIP supplemental Medicaid funding in his proposed 2017-18 budget, we urge his office to work with the Trump administration to secure at least $1.6 billion,” he said.

Scott’s proposed state budget would save $581 million by trimming Medicaid reimbursements to hospitals, and $298 million in supplemental money for for-profit hospitals that stint on charity and uncompensated Medicaid care.

They’d also like more freedom in how they spend charity dollars.

“Current LIP parameters for funding care for the poor and uninsured are too restrictive. Federal officials need to remove the allocation straight-jacket strapped on the state so Florida can direct that the precious LIP dollars be used to benefit the greatest number of patients in need,” Carvalho said.

“Federal officials need to remove the allocation straight-jacket strapped on the state so Florida can direct that the precious LIP dollars be used to benefit the greatest number of patients in need,” he said.

“Compounding Florida’s unfair charity care funding deficit is Florida’s precariously low Medicaid reimbursement rates. Today, even before the governor’s proposed $1 billion cut in reimbursements for services to Medicaid enrollees, hospitals are paid much less than the basic cost of providing the care.”

Low reimbursement for charity care forces a “hidden tax” on businesses in the form of higher insurance costs, he said. “Each year, Florida’s hospitals provide more than $3 billion in uncompensated and charity care that those with commercial insurance ultimately pay for.”

The alliance comprises teaching, public, and children’s hospitals that spend heavily on uncompensated and charity care.

Along for the Washington trip were Jonathan Ellen, chairman of the alliance board and CEO of Johns Hopkins All Children’s Hospital; Ed Jimenez, vice chairman and CEO of UF Health Shands Hospital; Carlos Migoya, president and CEO Jackson Health System; and Lindy Kennedy executive vice president and CEO of the alliance.

Executives from Halifax Health, Lee Health, Orlando Health, and Tampa General Hospital also were participating.

Federalism message echoed by Florida health subcommittee members

A day after Florida’s House Education Committee voted to send a memorial to Congress seeking fewer strings tied to federal education funding, a health policy panel made the same request for health care funding.

The House Health Innovation Subcommittee on Wednesday approved sending a memorial to Congress asking lawmakers to consider giving Medicaid funding to the states in the form of block grants.

“As you know, Medicaid is supposed to be a partnership. In reality, the federal government is in control,” said state Rep. Frank White, R-Pensacola, who introduced the memorial at the hearing.

“More than at any time in the past, states have the opportunity to have a serious, thoughtful discussion with the federal government about the nature of federal-state partnerships, like Medicaid, and what those successful block grants in Medicaid and other programs might look like,” White said.

White said effective Medicaid block grants would be based on the number of enrollees and adjusted for health risks and income levels. He argued that the states need flexibility to design programs tailored to their specific demographic and geographic needs.

In the public testimony on the memorial, speakers offered a mix of caution and enthusiastic support.

“In the redesign of health care, would you like to be in charge, as the state legislature? Or would you like a bunch of people in Washington to be in charge, dictating terms, creating more requirements, limiting your ability to manage the utilization of your own Medicaid program?” asked U.S. Rep. Matt Gaetz, a freshman Republican who previously represented the Panhandle in the state House.

Gaetz agreed that there were still details to iron out about how the block grants would work, but cited his previous experience as a state legislator and current experience in Congress as he told the subcommittee members that they were best suited to determining Florida’s needs.

“I can say with clear eyes that Washington screws everything up,” he said.

Sal Nuzzo, vice president of policy for the James Madison Institute, voiced his support for motivating Congress to move in the direction of federalism and allowing solutions for state-based health care access.

“The most efficient and effective way to guarantee access to actual care is the method of moving subsidization down to the state level where it can actually intersect with the specific needs of each state’s health population,” Nuzzo told the subcommittee.

Michael Daniels, executive director of the Florida Alliance for Assistive Services and Technology lobbying group, asked the members to proceed with caution, and to continue including the ultimate stakeholders — Florida patients — in the conversation.

Karen Woodall, policy director for the Florida Center for Fiscal and Economic Policy, argued that in the context of block grants, flexibility equaled an erosion of the protections afforded by federal benefit mandates.

Several Democratic lawmakers offered similar concerns.

The subcommittee approved the memorial on an 8-5 vote along party lines.

Via FloridaWatchdog.org.

VIDEO: Matt Gaetz in Tallahassee to promote Medicaid block grants

Congressman Matt Gaetz was in the Capitol Wednesday to discuss health care reform, including his support for a block grant funding method for Medicaid, the joint state-federal health care program for the poor.

After a structured media availability, the former state representative elected to Congress last year held a more informal gaggle with members of the Capitol Press Corps.

Gaetz, a Fort Walton Beach Republican, served in the Florida House for six years.

Below is a Periscope video of his Q&A in the House media room.

Nursing homes fighting plan to eliminate certificate of need program

The top legislative priority for Florida’s nursing homes this year is to kill a proposal, backed by Gov. Rick Scott, to repeal a requirement that they demonstrate a demand for new beds before they can expand or build new facilities.

SB 676, by Rob Bradley, and CS/HB 7 by Alex Miller, and would eliminate the certificate of need program at the Agency for Health Care Administration for all health care facilities.

Eliminating the requirement for nursing homes “would be extremely disruptive,” Florida Health Care Association chief lobbyist Bob Asztalos told reporters during a briefing Monday.

The association, which represents 82 percent of the skilled nursing facilities in Florida, fears competition from newer, shinier “Taj Mahal” facilities would drive down occupancy rates.

That’s what happened in Texas, where the occupancy rate hit 70 percent after the state scrapped its certificate of occupancy requirement, Asztalos said.

In Indiana, eliminating the requirement led to the construction of “so many buildings that they were looking at taxpayer money to buy buildings to take them off line,” he said.

“We don’t want to see Florida make the same mistakes,” Asztalos said.

Staffing levels would be “watered down,” said Rob Greene, CEO of Palm Garden Healthcare, which operates a network of facilities.

The association would like to see expansion limited to about 3,750 beds through July 2017, targeted to areas where they’re needed.

Free-market advocates, including Scott, argue an open marketplace would lower costs and increase quality.

“The government sets our rates. If there were a true free market, we would set our rates that the state would pay us for our care. But how do you have a free market where they set our rates?” Asztalos said.

The existing system is in the best interests of nursing homes, he conceded, but it also serves the state’s policy of placing patients in home- or community-based care.

“It’s not like nursing home A is going to steal beds from nursing home B. You’re going to look for people with high acuity who are in assisted living facilities, who are eligible for nursing home care or in home- or community-based care.”

“It’s really a bad idea,” said Emmett Reed, executive director of the association.

“I understand the free-market concept. But this is a public-private partnership. This is not a true free-market business we’re in.

He added: “I think that, philosophically, the governor wants to get it all on the table, to have the discussion. At the end of day, I think, he may have a reasonable ear for nursing homes when we discuss it with him.”

In other priorities, the association supports a proposed prospective payment reimbursement system — paying facilities on a per diem basis tied to factors including patient care and quality.

But it would like a three-year phase-in and more incentives to increase room size and build other improvements.

Additionally, representatives of the organization said, the state could save $68.2 million by exempting long-stay nursing home residents from Florida’s managed care system when it is demonstrated they can’t be moved to less intensive care settings.

Florida seniors, be careful what you wish for with Donald Trump, Medicare

Florida’s estimated 3.8 million senior citizens wanted change. They wanted to, how you say, drain the swamp? They voted overwhelmingly for Donald Trump in November.

With voters age 65 and over, Trump won Florida by 17 percent. That likely was the difference in a statewide race he won over Hillary Clinton by about 119,000 votes.

Here is part of the change they voted for. His name is Tom Price, just confirmed in the Senate as Trump’s secretary of Health and Human Services by a party-line vote of 52-47. Seniors may become better acquainted with him the next few years. He is the guy who The Washington Post says wants to privatize Medicare and Medicaid.

“Under his vision, both programs would cease to be entitlements that require them to provide coverage to every person who qualifies,” the Post reported. “Instead, like many House Republicans, he wants to convert Medicaid into block grants to states — which would give them more latitude from federal requirements about eligibility rules and the medical services that must be covered for low-income Americans.

“This plan would also require ‘able-bodied’ applicants to meet work requirements to receive health care benefits — an idea that the Obama administration has consistently rebuffed.”

I wonder how that will go over with the good folks in Charlotte, Sumter, Sarasota and Citrus counties. They are among the 11 “grayest” counties in the country.

Sumter, with nearly 53 percent of residents age 65 or older, ranks No. 1 on that list compiled by Pew Research. It is the only county in the nation to have that distinction.

Sumter, by the way, voted 69 percent for Trump. Charlotte, the second-grayest county in the land, delivered 62 percent in favor of Trump. Citrus was 68 percent. Sarasota was 54 percent.

To be fair, some of the angst over Price is about what he “might” do versus what he “can” do. He can’t just wave a calculator and do away with traditional Medicare and Medicaid, and for the time being his focus likely will be on reconfiguring the Affordable Care Act into something that will suit conservatives.

Congress would have to approve any major changes to Medicare and Medicaid, and although Republicans control both chambers President Trump has said he wants to keep things the way they are.

PunditFact rated claims by a Democratic website that Price wants to “phase out” Medicare as false.

Phase out? No.

Change? You betcha.

In case Price gets any funny ideas, though, AARP — the advocacy group for seniors — sent a letter Jan. 30 to a House committee holding Medicaid hearings warning block grants are something that could “endanger the health, safety, and care of millions of individuals who depend on the essential services provided through Medicaid.”

Shifting these programs to block grants would have a huge impact on Florida’s budget, given the high percentage of seniors living here. Imagine how long it would take for state representatives to run those budget numbers and decide nope, we can’t afford that.

This is just the first inning of what promises to be a long game in the contentious debate over these social safety nets for seniors. It’s also true, though, that House Republicans have had this issue in their crosshairs for decades and now they have a shot at reform — whatever that means.

If that happens, it will be too late for Sumter, Charlotte, Citrus and Sarasota counties to demand a recount. Those voters wanted change. Careful what you wish for.

Rick Scott: Obamacare expanded the welfare state

Florida Gov. Rick Scott, who has asserted that he is helping President Donald Trump work on a replacement for “Obamacare,” made his feelings known about the Affordable Care Act again on Friday.

In an editorial on CNN‘s website, Scott made a number of points.

Among them, that the Affordable Care Act was nothing more than an expansion of the welfare state, and an usurpation of state’s rights when it comes to handling Medicaid.

“With Obamacare,” Scott writes, “President Obama enacted a massive expansion of the welfare state. And, not surprisingly, Obamacare has resulted in widespread increases in premiums and costs are expected to continue increasing.”

Scott’s preferred option — and likely the one the Trump administration will land on — block grants to the states for low-income health care.

“States can do a far better job administering the Medicaid program than the federal government can. If Florida is given the flexibility to run our own Medicaid program, we will be more efficient and less wasteful than the federal government,” Scott notes.

“Liberal Democrats,” asserts Gov. Scott, “have a game plan for America: everything for free, provided by the government, paid for with your tax dollars. There is a name for this approach, and it is called socialism. President Obama gave it a try, and in the process he proved what we already knew — it does not work.”

“Government assistance must be the last resort,” Scott adds, “not the first stop. This is no time for Republicans to go wobbly or get weak in the knees about repealing Obamacare. If we refuse to roll back the welfare state, what real purpose do we serve?”

With many people expecting Scott, termed out next year, to challenge Democrat Bill Nelson for his Senate seat, an oped like this serves multiple purposes.

It reminds national conservatives that, when it came to Medicaid expansion, the governor fought Washington and won.

It allows the governor to frame the current debate around what he has accomplished in Florida.

And, most importantly, it provides a framework for what might come out of Washington this year regarding reform of the current health care schematic.

Expect more op-eds like this in the weeks ahead.

State asks feds to extend Medicaid managed-care waiver

Florida has asked the federal government for a five-year extension of a waiver that allows it to provide Medicaid services through a managed care program.

Gov. Rick Scott filed the state’s application on Friday, seeking to extend the program through June 30, 2022. The program would remain essentially the same.

“The demonstration objectives and the financial eligibility criteria for waiver recipients remain unchanged since the Managed Medical Assistance Program extension request was approved June 31, 2014,” Scott wrote in a cover letter to Department of Health and Human Services Secretary Sylvia Burwell.

“The program is designed to provide primary and acute care to the majority of Florida Medicaid recipients without increasing costs,” Scott wrote.

The federal Centers for Medicare and Medicaid Services first gave Florida permission to treat recipients through managed care, rather than fees for service, in 2013.

“The MMA program improves health outcomes for Florida Medicaid recipients while maintaining fiscal responsibility,” the Florida Agency for Health Care Administration wrote in the application.

“This is achieved through care coordination, patient engagement in their own health care, enhancing fiscal predictability and financial management, improving access to coordinated care and improving overall program performance,” the agency said.

The move comes as Republicans in Congress prepare to act on their vow to dismantle the Affordable Care Act.

Meanwhile, Florida Senate President Joe Negron has called for shifting Medicaid to block grant funding that would allow the state “to build a program that looks like Florida and addresses our issues.”

Congressional Puerto Rico task force releases final recommendations

A bipartisan Congressional task force heavily influenced by Florida’s U.S. Sens. Bill Nelson and Marco Rubio released its final report Tuesday on dealing with Puerto Rico’s economic collapse offering scores of recommendations for helping the U.S. territory, its economy and it’s people.

Authorized last summer by the Puerto Rico Oversight, Management, and Economic Stability Act, or “PROMESA,” the task force has been working for six months to prepare a blueprint for the official federal agency created in that same law that will oversee the territory’s economic governance for the near future, the Puerto Rico Financial Oversight and Management Board.

Most of the recommendations could be passed by Congress and signed by the president, pushing reforms independent of the management board. Some are recommendations for the island’s commonwealth government to tackle. Others fall more in line with hopes for changes.

“The Task Force is of the view that Puerto Rico’s best days lie before it, not behind it.” the Congressional task force members including Nelson and Rubio wrote in a joint statement issued Tuesday. “The members of the Task Force have worked across party lines to identify steps that can be taken to help Puerto Rico’s economy stabilize and grow. The Task Force hopes that its work will serve as a platform for continued bipartisan efforts to support the American citizens in Puerto Rico.”

The island’s economy is spiraling downward, and the governor announced in June of 2015 that the Puerto Rico government could not pay its $70 billion in debts. Unemployment, poverty and crime rates are higher than any state’s. Puerto Ricans are fleeing by the ten thousand a month, mostly to Florida, and overwhelmingly to Central Florida. Island schools, first-responder agencies and other agencies have been cut to what many observers say are critically low levels. Health care reportedly has been particularly rocked by inequitable Medicaid rates, a mass exodus of doctors and other health care providers, and the epidemic outbreak of the Zika virus.

The congressional report is 125 pages long.

Among the task force’s recommendations:

* Repeal an exemption in a 1940 law that otherwise provides some investment protection to companies.

* Congress needs to enact an equitable and sustainable legislative solution to the financing of Puerto Rico’s Medicaid program early in 2017.

* Changes also should be made to how Medicare is administered on the island, possibly changing the opt-in requirement for Puerto Ricans who want Medicare Part B.

* Congress should expand the federal child tax credit in Puerto Rico so families there with one or two children can claim it just as families in the states do.

* Congress also should consider other tax reforms to bring Puerto Rico’s tax laws more in line with the states.

* Increase the amount of excise tax on Puerto Rico and Virgin Islands rum, and imported rum, that is paid back to the island’s government.

* Congress should extend the tax deductions available in the states for qualified film, television, or live theatrical productions to Puerto Rico.

* The government of Puerto Rico should fully reform the Puerto Rico Electric Power Authority, which the task force said “does not inspire confidence” with its high-priced and unreliable electrical production and grid.

* The National Science Foundation, in collaboration with other government and non-government stakeholders, take all feasible steps to ensure continued operation of the Arecibo Observatory.

* The government of Puerto Rico should make it a priority to redevelop the former Naval Station Roosevelt Roads.

* The U.S. Army Corps of Engineers should expedite plans to restore the Martín Peña Channel.

* Congress should consider whether to authorize Puerto Rico to have greater flexibility in its use of Unemployment Compensation benefits for the purpose of increasing employment.

* The Small Business Administration should assess and reform its rate structures, limits, and contribution formulas for making small business loans in Puerto Rico.

* Congress should create a program for contracting preference program for Puerto Rico small businesses to participate in federal contracts.

* Congress should enact a law allowing Zika virus and other communicable diseases to qualify as a “disaster,” making affected small businesses eligible for emergency loans.

* Congress should hold a hearing to determine if Social Security Supplemental Security benefits should be extended to disable people in Puerto Rico.

* The government of Puerto Rico should develop a comprehensive economic development strategy that exploits the island’s many comparative advantages.

* Someone with expertise in Puerto Rico tourism should be appointed to the United States Travel and Tourism Advisory Board.

* The U.S. Economic Development Administration should base its Puerto Rico representative in Puerto Rico, rather than in Philadelphia.

* And, regarding future status – statehood, independence, continuance as a U.S. Territory, the Task Force simply stated Congress should take it seriously: “If the government of Puerto Rico conducts a plebiscite authorized and funded by Public Law 113-76, the Task Force recommends that Congress analyze the result of this plebiscite with care and seriousness of purpose, and take any appropriate legislative action,” the task force concluded.

 

Joe Negron envisions block grant system for Medicaid in Florida

Senate President Joe Negron wants to start preparing for a day when Congress turns the Medicaid system into a block-grant program administered by the states.

“What I’d like to see the Legislature do … is to start building the framework of what a block grant program would look like now that there is a reasonable chance that that could happen,” the Stuart Republican told reporters Tuesday during a briefing in his Capitol office.

“I don’t want to wait until the federal government acts and Congress acts and we go into the next session and try to build it. I would like to fill out the model of what a Florida-run Medicaid would look like, and then — if and when Washington acts — Florida would be ready to go.”

Republican President-Elect Donald Trump has proposed switching Medicaid, which mostly covers low-income people, from an entitlement program largely paid for by the federal government into block grants that would allow states to exercise more control. They could save money by providing care to fewer people.

Negron cast his proposal in more generous terms.

“Rather than treating Medicaid as a program where even the vocabulary that we use is disparaging, in my opinion — we say someone is on Medicaid, as if it’s an addiction; no one says, ‘I’m on health insurance’ — use an ownership adjective,” he said.

“I would like to see a system that empowered our friends and neighbors, millions of them, who get their health care from Medicaid.”

In other words, Medicaid no longer would represent “second-tier medical care,” Negron said.

“That’s what I aspire to. Part of that would come if the state is given the opportunity to build a program that looks like Florida and addresses our issues.”

Such a system also might address the “Medicaid gap” — a problem for people in states, like Florida, that passed on Medicaid expansion under the Affordable Care Act. Many people make too much to qualify for Medicaid but don’t quality for insurance subsidies through that law’s federal insurance exchange.

“I would hope that we would address that,” said Negron, who opposed expanding Medicaid under the ACA, which he would like to see repealed.

“If there’s a block grant program to the state, that opens an opportunity to a new discussion,” he said.

As for the loss of insurance subsidies if Republicans in Congress repeal the ACA, “that’s an issue we would have to address if and when that happens.”

Donald Trump action on health care could cost Planned Parenthood

One of President-elect Donald Trump‘s first, and defining, acts next year could come on Republican legislation to cut off taxpayer money from Planned Parenthood.

Trump sent mixed signals during the campaign about the 100-year-old organization, which provides birth control, abortions and various women’s health services. He said “millions of women are helped by Planned Parenthood,” but he also endorsed efforts to defund it.

Trump once described himself as “very pro-choice.” Now he’s in the anti-abortion camp.

Still, the Republican has been steadfast in calling for repeal of President Barack Obama‘s health care law, and the GOP-led Congress is eager to comply. One of the first pieces of legislation will be a repeal measure that’s paired with cutting off money for Planned Parenthood. While the GOP may delay the impact of scuttling the law for almost four years, denying Planned Parenthood roughly $400 million in Medicaid funds would take effect immediately.

“We’ve already shown what we believe with respect to funding of Planned Parenthood,” House Speaker Paul Ryan, R-Wis., told reporters last month. “Our position has not changed.”

Legislation to both repeal the law and cut Planned Parenthood funds for services to low-income women moved through Congress along party lines last year. Obama vetoed it; Trump’s win removes any obstacle.

Cutting off Planned Parenthood from taxpayer money is a long-sought dream of social conservatives, but it’s a loser in the minds of some GOP strategists. Planned Parenthood is loathed by anti-abortion activists who are the backbone of the GOP coalition. Polls, however, show that the group is favorably viewed by a sizable majority of Americans — 59 percent in a Gallup survey last year, including more than one-third of Republicans.

“Defunding Planned Parenthood as one of their first acts in the new year would be devastating for millions of families and a huge mistake by Republicans,” said incoming Senate Minority Leader Chuck Schumer, D-N.Y.

Democrats pledge to defend the group, and they point to the issue of birth control and women’s health as helping them win Senate races in New Hampshire and Nevada this year. They argue that Trump would be leading off with a political loser. But if he were to have second thoughts and if the Planned Parenthood provision were to be dropped from the health law repeal, then social conservatives probably would erupt.

“They may well be able to succeed, but the women of America are going to know what that means,” said Rep. Diana DeGette, D-Colo., citing reduced access to services Planned Parenthood clinics provide. “And we’re going to call Republicans on the carpet for that.”

At least one Republican senator, Susan Collins of Maine, may oppose the effort. Collins has defended Planned Parenthood, saying it “provides important family planning, cancer screening and basic preventive health care services to millions of women across the country.” She voted against the health overhaul repeal last year as a result.

Continued opposition from Collins, which appears likely, would put the repeal measure on a knife’s edge in the Senate, where Republicans will have a 52-48 majority next year. Senate GOP leaders could afford to lose just one other Republican.

Anti-abortion conservatives have long tried to cut Planned Parenthood funds, arguing that reimbursements for nonabortion services such as gynecological exams help subsidize abortions. Though Planned Parenthood says it performed 324,000 abortions in 2014, the most recent year tallied, the vast majority of women seek out contraception, testing and treatment of sexually transmitted diseases, and other services including cancer screenings.

The drive against Planned Parenthood picked up steam in 2015 after an anti-abortion group called the Center for Medical Progress released secretly-recorded videos that it claimed showed Planned Parenthood officials profiting from sales of fetal tissue for medical research. The measure, however, would strip Planned Parenthood’s Medicaid funding for only a year, a step taken to give time for continued investigations of Planned Parenthood’s activities. A House panel is still active, but investigations by 13 states have been concluded without charges of wrongdoing.

Planned Parenthood strongly denied the allegations and no wrongdoing was proved, but the group announced in October that it will no longer accept reimbursement for the costs involved in providing fetal tissue to researchers.

The defunding measure would take away roughly $400 million in Medicaid money from the group in the year after enactment, according to the nonpartisan Congressional Budget Office, and would result in roughly 400,000 women losing access to care. One factor is that being enrolled in Medicaid doesn’t guarantee access to a doctor, so women denied Medicaid services from Planned Parenthood may not be able to find replacement care.

Planned Parenthood says private contributions are way up since the election, but that they are not a permanent replacement for federal reimbursements. “We’re going to fight like hell to make sure our doors stay open,” said Planned Parenthood spokeswoman Erica Sackin.

Republished with permission of The Associated Press.

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