Medicaid Archives - Page 7 of 31 - Florida Politics

A $30 million hospital issue could get tucked into Medicaid conforming bill

During the contentious debate over Medicaid expansion top Republicans in the Florida House railed against hospitals as special interests and part of the “health care industrial complex.”

Now the House is taking its battle against hospitals on multiple fronts, including trying to revive a little-noticed bill from the 2015 Regular session that cracks down on the ability for hospitals to challenge Medicaid reimbursement rates set by the state.

A staff analysis of SB 322 noted there were a number of hospitals that were challenging their rates and, if successful, the state could be on the hook for upward of $30 million.

Though the issue was heard only in the Senate during the Regular Session, it was offered up by the House during the Special Session budget conference process. The Senate deferred acceptance which means the issue will be hammered out by the House and Senate’s chief budget writers.

The House proposal makes clear that if hospitals prevail in their challenges to the rates they must secure an appropriation from the Legislature in order to collect the money.

“The agency may not be compelled by an administrative body or a court or pay additional compensation to a hospital” the language offered by the House in the Medicaid conforming bill, SB 2508 A, reads.

The offer also would change the rules with regards to rate challenges to make clear that written notification of the audited rates is a “final agency action” and that the hospitals may request and administrative hearing to challenge the rates by filing a petition with the agency within 180 days. Hospitals could challenge the methodologies set forth in the rules used to calculate the rates for a retroactive period of three years from the date of the challenge.

Sen. Kelli Stargel filed the bill during the 2015 regular session and it was heard by the Health Policy and Fiscal Policy committees and was passed unanimously.

Daniel Tilson: Florida's uninsured left standing in the shadow of hopelessness

Shirley dragged long and hard on her lipstick-stained cigarette. She alternated between shaking and nodding her head while listening to new friend Toni talk trash about politicians.

“They did it again, threw us under the bus. They don’t know us, they don’t give a damn about us, we’re just bugs on their windshield, that’s all, just as long as we get wiped out of the way, don’t matter whether we live or die, now does it?”

“To hell with them,” spit out Shirley, peeling the cigarette filter off her lower lip and throwing the barely still-smoking bit of a leftover butt to the ground below. “Life and death matters to me, matters to my momma, matters to my God, my sisters and brothers…maybe even to my nieces and nephews…” That made her stop and smile a second before her lips curled back down.

”Staying alive matters to me and mine,” she said, patting at her chest.

Amen, Sister,” said Toni. “Poor colored people’s lives mean just as much as those rich white men making and breaking the rules up in Tallahassee.”

The two black women stood huddled together in darkness near the hospital Emergency Room entrance. Toni had introduced herself as “Tiny Toni” when asking for a cigarette – five-feet-one-inches of skin and bones surrounding oversized, searching eyes, full of emotion. When she looked up at six-inches-taller and severely obese Shirley squinting down at her, you might have thought they really were sisters.

But the two women were strangers until fate took them both by surprise this night.

Shirley woke up in a sweat, heart pounding, out of breath. She’d spent the first half of the day looking for work at local restaurants and stores, the second half watching her sister’s three kids…and the night feeling physically worse and worse. With no health insurance or doctor of her own, no medicine and almost no money…she ended up waiting 25 minutes for a bus to the local ER. Now she was waiting for care.

When Toni saw and approached her, it was an hour into her own wait for word on her boyfriend Ron. She and Ron, both stuck in poverty-wage jobs with no health insurance or other benefits, had spent the afternoon fishing in a canal near the rooming house where they lived. When they finally caught one big enough to want to keep, Ron couldn’t gut and clean it. His hands were numb and tingling. Eight hours later and barely any better, Toni got him to the ER. Now she waited and worried.

It was after midnight but still 82 degrees and steam-bath humid in this South Florida tourist town. Most residents were fast asleep in their condo colonies and HOA communities, secure in the knowledge they were covered by private insurance or Medicare. But in the far corner of town where most of the low-income black folks lived, there was rampant insecurity, there was restlessness, sleeplessness…and ever-growing hopelessness.

Shirley lit another pair of cigarettes for her and Toni, talking between puffs and coughs. “You know…I had a little hope, when I heard Obamacare was going to get us all health insurance. Should’ve known the powers-that-be and the crackers that put them there would never let that happen…not in Florida.”

Toni laughed as Shirley handed her a lit cigarette. “But look how polite they are now when they’re stabbing us in the back, no more calling us ‘welfare queens,’ or worse. Now, we’re ‘able-bodied childless adults!’ ”

Shirley looked down at the ground. “Still their victims, by any other name…”

Both women were startled by the sound of the ER doors sliding open nearby. An orderly stuck his head out and shouted. “Toni Livingston?”

Toni’s already-fading smile was swallowed up by anxiety in a heartbeat as she hurried to him. “I’m Toni, you have news on my man, Ron Wilford? Has he got feeling back, is he – ?”

Shirley watched them walk inside, calling out, “Good luck, I’ll say a prayer…hoping for the best.” Then she threw her cigarette down and stomped on it for several extra seconds, before taking a long, deep breath and heading back inside to wait for help.

Daniel Tilson has a Boca Raton-based communications firm called Full Cup Media, specializing in online video and written content for non-profits, political candidates and organizations, and small businesses. Column courtesy of Context Florida.     

“It really is a dire situation,” say advocates for state’s uninsured

As Florida legislators try to iron out their differences over the state’s major budget items, advocates for Florida’s nearly 1 million uninsured are speaking out about Friday’s House vote rejecting  the Senate’s Medicaide expansion compromise.

“It really is kind of a dire situation,” said Sarah Sullivan, director of Florida Coastal School of Law’s Disability and Public Benefits Clinic. The clinic works with the disabled and their caregivers who have trouble accessing health care benefits. Sullivan spoke during an appearance on WJCT’s First Coast Connect.

“We help the uninsured and underinsured. We’re problem-solvers, and try to refer people to safety net services,” she said.

“And the feedback we’re getting from people after this vote is the fear that now, the uninsured will go to the emergency room even more. That means a rise in costs; that means a rise in premiums for the insured, so it’s going to cost one way or another.”

FCSL law student Jenny Rose is employed but uninsured, and also studying for the bar exam. Rose said she and her family are among the 900,000 Floridians who fall into the so-called “doughnut hole” of coverage: They cannot afford health insurance but are not poor enough to qualify for Medicaid.

‘I was very disappointed,” she said. “I have a large family. My 6-year-old has asthma, and my husband suffers from congestive heart failure, so this affects us in a very bad way.”

“Right now we call and negotiate with our doctor. We pay out-of-pocket for actual office visits. We also have to cover for meds and if we need blood work that’s a big problem too. Those are all separate bills that we cannot afford.”

Because the way forward for health care coverage remains in flux, state House lawmakers such as Rep. Paul Renner of Palm Coast say they’re concerned about the long-term effects Medicaid expansion might have on the state budget.

“It’s really not a free proposition for us to expand coverage here,” Renner told The Florida Times-Union. “We’re going to have to give up things that are very important, like education.”

Gov. Rick Scott, who changed his mind several times about the issue of Medicaid expansion, has also expressed concern about the expense, estimating it would cost the state $5 billion over the next decade.

Rose says she understands the concerns but hopes legislators hear her point of view, too.

“I just hope that people understand that it’s not a Republican or Democratic problem, it’s a people problem. And we all should be concerned about the health of our fellow humans.”

Rick Scott demands mediation in Medicaid lawsuit with feds as lawmakers craft budget

As lawmakers work on a 2015-16 spending plan with a $1 billion Low Income Pool for health care spending, Gov. Rick Scott continues to push for more money and is looking to the courts to help him get it.

On Monday, attorneys for the governor filed a five-page motion with the federal court in Pensacola that, if granted, would require the state and federal governments to go to mediation. Scott’s lawyers argue that the mediation is allowable under “home rule.”

“Under the circumstances court-ordered mediation would be appropriate to faciliate a decision within a timeframe that allows the Florida Legislature to pass a budget that ensures that state healthcare providers, ranging from trauma centers to children’s hospitals receive the funding necessary to provide critical medical services to needy residents,” the motion reads.

“By introducing a neutral mediator and insulating the process from extraneous influences, court ordered mediation could facilitate a long overdue conclusion to these negotiations quickly, equitably, permanently, and–perhaps most importantly–constitutionally, and do so in a timeframe that respects, rather than deliberately frustrates, the state’s impending budget deadline.”

The federal government advised Florida in late May that the state could expect to receive a $1 billion supplemental Low Income Pool program for the 2015-16 fiscal year and, additionally, a $600 million program for the 2016-17 year. The tentative green light for a $1 billion program returns LIP funding to prior year levels but would cut it in half from current year spending.

Because of the reductions the Florida Legislature agreed to use $400 million in recurring general revenue to backfill the loss of federal dollars and budget conferees have been meeting over the weekend in hopes of hammering out not just an agreement on the health care budget but the entire spending plan for the upcoming fiscal year which begins July 1.

The decision by legislators to put $400 million in general revenue means Scott’s priorities won’t be funded at the level he requested. When asked how the governor felt about the general revenue being used to backfill the loss of federal dollars his staff over the weekend said the governor was watching the process.

Despite using the $1 billion figure in the budget, the governor’s attorneys argue that the Legislature finds itself in the midst of a special session on the budget but does not have a resolution of LIP.

“The state cannot possible anticipate at this point whether any semblance of its LIP program will continue to exist or how it will be funded if it exists at all,” attorneys for the governor wrote.

“Each day that passes without a resolution to this matter heightens the tension at the state Capitol …. (and) (d)efendants appear determined to leave the fate of the LIP program in limbo until long after that date–presumably in an effort to coerce the state into expanding Medicaid or to punish the state for failing to ultimately do so.”

The federal government advised Florida last April that the supplemental Medicaid program called Low Income Pool, which was $2 billion in 2014-15 year, would expire this summer. In preparing his budget for the upcoming fiscal year Scott assumed the full $2 billion would be available. Scott’s proposed budget included record increases for education funding as well as more than $600 million in tax reductions.

In spring federal officials from CMS reiterated at an Associated Industries of Florida-sponsored health summit in Orlando that the LIP would not be extended in its current form. The Legislature did not know how much LIP money it could expect to receive for the 2015-16 year and. as such, was not able to pass a budget and adjourn the session on time.

Scott sued the federal government in court and also requested a temporary injunction that, if approved, would require the feds to keep funding LIP at $2 billion.

A hearing on that has been set for July 19 in Pensacola.

Rick Scott’s office on health care funding: “We are continuing to watch the process”

After making quick progress early on Saturday, legislative health care budget writers announced at 4 p.m. they won’t meet again until Sunday.

House and Senate legislative leaders have agreed to pour $400 million in recurring general revenue into hospitals in an attempt to absorb the loss of $1 billion in supplemental Medicaid funding known as the Low Income Pool.

It’s a move that could put the Legislature at odds with Gov. Rick Scott who has said he doesn’t want to “backfill” the loss of federal funds with state general revenue.

Scott’s spokeswoman Jackie Schutz, said the governor  is “continuing to watch the process,” when asked how Scott felt about the move.

Matt Hudson, chief of the House health care budget, said legislative leaders agreed on the approach. The GR was allocated to “make sure we are keeping our system solvent and making sure we are being responsible to our hospitals as well. I think everybody is allowed to have different approaches. This is one our presiding officers agreed on.”

When pressed about Low Income Pool details Hudson said his committee would “take a deep-dive look later today” on how to disperse the LIP funds among the hospitals.

The Senate agreed to back off its commitment to graduate medical education. Both Hudson and his counterpart Sen. Rene Garcia said after the meeting that the issue is not “off the table.”

The $400 million is about $30 million less than what the hospitals wanted to offset the LIP reductions.

There have been no public discussions to date about so-called “rate relief” for Medicaid HMOs participating in the Statewide Medicaid Managed Care program. The HMOs sent a letter to Agency for Health Care Administration Secretary Liz Dudek pressing for a rate increase but Dudek shot back telling the medical plans that the rates aren’t warranted.

Finally … chambers set for Saturday conference on budget

The Florida Senate was in session for less than five minutes on Friday before adjourning.

Senate President Andy Gardiner announced that the House and Senate had agreed to budget allocations and that the two chambers would begin hammering out the differences in the proposed spending plans for the 2015-16 fiscal year beginning at 9 a.m.

Those were the only details that Gardiner, or his usually chatty budget chair Sen. Tom Lee, divulged early Friday. In other words, they didn’t announce what allocations each budget committee would have to spend.

“I think you’ll see general revenue going into Low Income Pool. I think you’ll see us do everything we can to fully implement Amendment 1,” Gardner said.

“We are very committed, as the House is, to providing a tax package that we can be proud of. That’s our commitment and we hope to put that all together in the next four or five days.”

Gardiner said he wanted to speak to his subcommittee chairs before disclosing any figures.

Gov. Rick Scott said during the spring that he would not use general revenue to backfill the loss of any Low Income Pool money so the announcement that the chambers have agreed to plug general revenue into hospital funding could put the chambers at odds with the governor.

“I’m trying to stay in the moment. I don’t know what’s going to happen,” Lee said when asked whether the move to use general revenue could result in a veto. “You are wise to keep one eye on what might or might not be acceptable at the plaza level. But they are going to watch us work. They know we are up here doing our job.

“If they have input they’ve got my number and I’d love to chat with them anytime. But I don’t have any real concern about it at this moment based on the conversations I had with them in the Regular Session.”

The Legislature also is not using a proposed Low Income Pool formula that Deputy Secretary for Medicaid Justin Senior floated at the eleventh hour that would put all LIP funding into hospital rates. The proposal has not been agreed to by the federal government. Lee said the alternative LIP proposal floated by Senior won’t be used in the Legislature’s budget.

The chambers were able to agree to allocations after the federal government put Florida on notice that it could expect to receive $1 billion in Low Income Pool for the 2015-16 year and another $600,00 in 2016-17.

The agreement also was reached after the House of Representatives agreed to consider the Senate’s proposal to expand health care access called FHIX.

Federal judge schedules hearing on Rick Scott’s Low Income Pool lawsuit

A federal court in Pensacola has scheduled a hearing on Gov. Rick Scott‘s lawsuit against the U.S. Department of Health and Human Services and preliminary injunction to require the federal government to keep Low Income Pool funding at more than $2 billion.

The hearing in Scott v. Department of Health and Human Services is scheduled for June 19, one day before the scheduled end ot the 2015A special session on health care and the budget.

Chief Judge Casey M Rodgers issued an order on Friday noting that “upon review of the motion and response, the Court finds that oral argument would be beneficial in the consideration of the issues presented.” Rodgers was appointed to the court by then-President George W. Bush in 2003.

The federal government unsuccessfully argued in a 35-page motion filed June 1 that “judicial involvement in the administrative review process and ongoing discussions between the Secretary and Florida would be both inappropriate and unnecessary.”

The government also argued that the state did not show a likelihood of success on the merits or to satisfy any of the prerequisites for emergency relief.

Scott filed a lawsuit shortly after the House of Representatives adjourned for the regular Legislative Session because of an impasse on Medicaid expansion and the Low Income Pool program. The governor argued that the federal government suddenly ended the supplemental Medicaid program as a way to force the state into a Medicaid expansion under the federal health care law, often called Obamacare.

“This administration is effectively attempting to coerce Florida into Obamacare by ending an existing federal healthcare program and telling us to expand Medicaid instead. This sort of coercion tactic has already been called illegal by the U.S. Supreme Court,” the lawsuit notes.

House poised to vote down Senate’s Medicaid expansion bill

House Republicans appeared ready to reject the Senate’s plan on Medicaid, arguing Thursday that it is essentially an expansion that relies on money from the president’s health care overhaul.

During a tense 2 1/2 hours of questions, House Republicans agreed the Senate plan was still a government entitlement program for “able-bodied adults” that would increase the federal deficit. House Speaker Steve Crisafulli said it was a “safe assumption” that the bill would be defeated on Friday.

“It’s the same program rules, same population, same bucket of money,” Crisafulli said, referring to President Barack Obama‘s health care overhaul. “It’s Medicaid expansion regardless of what others say.”

Rep. Mia Jones, a Democrat, stressed that the bill would not expand Medicaid and would save the state an estimated $547 million and draw down more than $18 billion federal dollars to help the additional Medicaid population buy private insurance. She warned that if the House doesn’t pass the bill and continued to rely on a federal program that reimburses hospitals that care for the uninsured, they would have to deal with the issue again next year.

“Today I am standing with the weight of hundreds of thousands of Floridians on my shoulders,” said Jones, of Jacksonville.

The House and Gov. Rick Scott want the Obama administration to extend the hospital funding known as the low-income pool. But the Senate, the Obama administration and hospital groups want the state to expand Medicaid, arguing it’s more efficient to use federal funds to give people insurance than to pay hospitals for caring for the uninsured retroactively.

The Obama administration agreed to extend the hospital funds, but only at half the amount. Medicaid expansion is a key objective of Obama’s health law, but the governor and many House Republicans are opposed to accepting any money tied to so-called Obamacare.

The White House on Thursday bolstered its argument for Medicaid expansion, releasing a study from its economists saying it would provide insurance to 750,000 Floridians, improve access to health care, improve health and offer greater financial security.

During the Special Session that started this week, the Senate added several amendments to try to address concerns raised by the House. Those changes included requiring recipients to work or attend school and pay small premiums. Republicans were not appeased and said those changes were unlikely to get approval from the Obama administration.

“You’re saying that president Obama’s signature legislation the Affordable Care Act has no work requirement in it for Medicaid expansion … yet you are expecting your leader and your administration to approve a plan that requires work,” said GOP Rep. John Wood, of Winter Haven.

Jones said all of the requests had been approved in other states except for the work requirement.

GOP Rep. Matt Hudson, of Naples, complained the bill would add to the federal deficit.

“The money that’s coming from the federal government, wouldn’t that be borrowed?” Hudson said.

Several Republican senators noted Wednesday when they passed the bill that the state already borrows a significant amount of federal dollars for other programs, including transportation.

“Save us this rhetoric on long-term debt and entitlement growth,” Democratic Sen. Arthenia Joyner said.

Republished with permission of The Associated Press.

Medicaid expansion would trim $790 million in uncompensated care in Florida, report shows

As the House prepares to debate — and most likely vote down — the Senate’s plan to expand access to health care, the White House Council of Economic Advisors released an analysis that shows expansion would reduce the state’s uncompensated care costs by $790 million in 2016.

The report also shows that expanding coverage would result in an estimated 100,000 additional Floridians reporting being in good health and 69,000 fewer residents would suffer depression.

The findings in the report — dubbed Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid — show that the projected number of Floridians receiving preventive care would increase if Medicaid were expanded and that in 2016:

  • 109,300 more people would have preventive cholesterol screenings;
  • 31,200 women would have mammograms, and;
  • 46,100 women would receive papanicolaou smear test.

The estimates are based on a traditional Medicaid expansion as envisioned by the Affordable Care Act, which is different than  the Florida Senate’s proposed FHIX plan that  would place work requirements on newly eligible enrollees as well as require co-payments for care.

The report does not identify the state’s uncompensated care costs, just the projected savings under expansion. To help offset the high costs of uncompensated care Florida has been able to have a supplemental amount of Medicaid funding called Low Income Pool. LIP funding was one of the main reasons the Florida Legislature could not resolve draft a budget for the 2015-16  year during the regular Legislative Session.

Other findings in the report: Medicaid expansion would mean an additional 2 million plus physician visits each year and  another 100,000 Floridians would be relieved from financial stress by no longer having to borrow money to pay medical bills or to skip payments on other bills in order to pay medical expenses.

The study also suggests that 750,000 people would have access to health care who don’t have it today.

“The administration is willing to work with any state interested in expanding Medicaid,” Vikki Wachino, acting director, Center for Medicaid and CHIP Services, said in a prepared statement. “We are committed to supporting state flexibility and working with states on innovative solutions that expand Medicaid to low-income individuals in accordance with the law’s goals and consumer protections, while securing quality, affordable health coverage and growing a state’s economy.”

The Affordable Care Act, often called Obamacare, encourages states to expand Medicaid to those with incomes at or below 138 percent of the poverty level. Expansion is paid for completely by the federal government through 2016. The federal government will pay 95 percent of the costs in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019, and 90 percent in calendar years 2020 and beyond.

In reaching its conclusions, the Council of Economic Advisers obtained information on insurance coverage and the amount of federal funding entering the state from Urban Institute and the Congressional Budget Office. It also used information from the Oregon Health Insurance Experiment, stemming from Oregon’s decision in early 2008 to reopen enrollment to some adults with incomes under 100 percent of the federal poverty level based on a lottery.

To date, 28 states and Washington, D.C., have expanded Medicaid under the Affordable Care Act. Twenty-two states, including Florida, have not expanded coverage. Since major provisions of the law took effect at the start of 2014 the nation has seen “the sharpest reduction in the uninsured rate since the decade following the creation of Medicare and Medicaid,” the report notes, adding that as of early 2015 more than 16 million people have gained health insurance.

Senate passes health care expansion bill by 33-3 vote

It was not unanimous but the Florida Senate on Wednesday passed a bill off the floor to use Medicaid funding under the Affordable Care Act, often called Obamacare, to expand access to health care for low income uninsured Floridians.

Passed by a 33-3 vote, SB 2-A was amended and debated the same day so it could be sent to the House of Representatives, which remains steadfast in its opposition to the measure. But bill sponsor Sen. Aaron Bean said he hopes the bill will give the “spark that starts the dialogue” between the House and Senate and that a health care access plan will be developed.

SB 2-A was passed after many members gave impassioned speeches about why the health care bill should be passed. The reasons ranged from sending a message to Washington, D.C., that a traditional Medicaid expansion won’t be endorsed in Florida to helping those who are in need help themselves.

It was amended to include concerns that the Agency for Health Care Administration had flagged with the proposal in a critical analysis that was prepared by the agency and shared with the House of Representatives but not the Senate. AHCA had flagged that the premium structure could result in a “death spiral” because FHIX plans could not be medically underwritten but the subsidies new enrollees would have access to would be risk adjusted, meaning healthier people would get less subsidies and sicker people higher subsidies.

AHCA, bill sponsor Bean said, helped Senate staff address the potential death spiral issues and drafted two amendments that were tagged onto the bill. However, the amendments were not enough for agency Secretary Liz Dudek to endorse the plan. Dudek’s boss is Gov. Rick Scott, who has flipped positions on Medicaid expansion.

“We still have many concerns with other areas of the bill, which would make it uncertain whether the FHIX plan will be able to provide more Floridians with health coverage,” Dudek said in a press statement.

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