Michael Moline
Florida’s congressional delegation is onboard with efforts by hospitals that provide charity care to persuade the Trump administration to treat the state more fairly under the Medicaid program, representatives said following meetings in Washington.
Members of the Safety Net Hospital Alliance of Florida met this week with senators Marco Rubio and Bill Nelson, and with House members Carlos Curbelo, Stephanie Murphy, and Ted Yoho, and with aides to other members of the delegation.
“We had a very warm reception at Sen. Rubio’s office. He was very well aware that Florida gets short-changed in our funding for the uninsured, and was energized,” Lindy Kennedy, executive vice president of the alliance, said during a conference call Thursday.
Rubio warned that Health and Human Services Secretary Tom Price was still organizing his management team, but promised the delegation “would do everything in their power” to press the hospitals’ case.
“Sen. Nelson was very gracious, spent a lot of time with us,” Kennedy said.
“He acknowledged the challenging, rock-and-a-hard place position that Florida’s hospitals now find themselves in, having aggressively worked with the federal government as well as our state Legislature to request passage of Medicaid expansion,” she said.
“He seemed to understand that we need to move forward with sort of the hand we’ve been dealt, was the way that he put it.”
Curbelo wants to write a letter from the delegation to Price. That’s not a sure thing, but “there is some interest in trying to pull that together,” Kennedy said.
But the state’s elected representatives understand the problem and want to help.
“That was a consistent theme with Congressman Yoho and Stephanie Murphy,” she said.
The representatives met with staff for Ron DeSantis, Mario Diaz-Balart, Francis Rooney, Tom Rooney, Dennis Ross, and Daniel Webster. Individual hospital representatives may have met with additional members of Congress.
“I understand they were very well received,” Kennedy said.
“We are working to follow up with Secretary Price’s new administration, and spending time with them, hopefully educating them about the disparity between Florida and some of the other nonexpansion states,” Kennedy said.
“We feel we’re uniquely positioned to maybe even lead the nation in setting policy” on supplemental funding for the uninsured, she said.
The alliance has complained that the Obama administration trimmed Florida’s reimbursement levels under the Low Income Pool program for uninsured patients from $2.2 billion to $608 million during the past three years.
It wants at least $1.6 billion during the new budget year, and more freedom in how they spend the money.
“I think that the unfairness shown to Florida in the past presents the Trump administration with an opportune platform to quickly demonstrate its new commitment to state flexibility in deployment of funding for health care to the uninsured and Medicaid patients,” Jonathan Ellen, CEO of Johns Hopkins All Children’s Hospital and chairman of the alliance board, said in a written statement.
The LIP program was launched 11 years ago under a waiver from the federal Center for Medicare & Medicaid Services, allowing Florida to put Medicaid recipients into managed care. Following two extensions, the state’s authority for that program ends on June 30.
The feds have been shortchanging Florida on the program for years, alliance president Tony Carvalho said — the state gets $401 per uninsured patient, compared to $1,612 for California, $1,934 for Texas, and $4,007 for New York.
“The federal government has treated Florida very unfairly,” Carvalho said.
“Florida’s Low Income Pool was reduced over the last several years as a strategy to pressure Florida to expand Medicaid coverage under ACA,” he said.
“We certainly support ACA expansion. But we believe the strategy really hurt the safety net hospitals and hurt the safety net in general — the people who are uninsured in this state.”
Gov. Rick Scott’s health aides are negotiating with the Trump administration but, with the Legislature settling into its session next week, and the state budget deadline looming, “time is running short,” Carvalho said.
“Whatever they do settle on, the Legislature would have to appropriate the money,” he said.
With the state House, particularly, looking for budget cuts this year, “we are concerned that the Legislature may be looking at rate cuts in the Medicaid program,” he said.
“Every dollar that they cut in hospital rates, if that should happen, the state saves 38 cents and we give back to the federal government 62 cents. If we’re starting from a basis in which we believe Florida is already in a very inequitable position in terms of its share of federal dollars, those types of cuts just are penny wise and pound foolish.”
Particularly if Washington Republicans enact major reforms, such as turning Medicaid into a block grant program, he said.
“The clock is ticking,” Kennedy said.
“We do need the Legislature and our federal delegation to work together with CMS to address this issue before sine die of our regular session, so the waiver can be renewed June 30 with increased flexibility and an increased amount,” she said.
“Everyone we met with (in Washington) and explained the different time-table, they acknowledged their understanding. They were very receptive, and I’m optimistic we will be able to move quickly with their help.”
