Medicaid Archives - Florida Politics

Report says loss of health care mandate would hit South, Central Florida hard

Three South Florida congressional districts represented by Republicans would be among the hardest-hit in the country according to a new report assessing how many people would lose or drop health care coverage if the final tax reform bill in Congress includes the U.S. Senate’s provision to repeal the individual coverage mandate in Obamacare.

A report “Estimates of the Increase in Uninsured by Congressional District Under the Senate GOP Tax Bill” from the Democratic-leaning Center for American Progress calculated the prospects for people dropping insurance in all 435 U.S. congressional districts, based on numbers produced by the Congressional Budget Office, if the Affordable Care Act’s individual mandate is repealed. The report, first produced earlier this week but revised late Wednesday, found the districts of U.S. Reps. Mario Diaz-Balart, Ileana Ros-Lehtinen and Carlos Curbelo all would be among the top seven in the country in the numbers of people dropping health care coverage.

Districts of Democratic U.S. Rep. Debbie Wasserman Schultz, Val DemingsAlcee HastingsDarren SotoTed Deutch, and Frederica Wilson would not be far behind.

Only one Florida member of Congress, Republican U.S. Rep. Dan Webster, could expect to see his district among the 100 in the nation that are least-affected by projected health care coverage reductions, according to the center. Florida’s 11th Congressional District in west-central Florida could expect to lose 24,100 people from health care coverage, the 18th-least among the nation’s 435 congressional districts.

The fate of the mandate is in the hands of the congressional conference committee, as the tax reform bill approved by the Senate includes the mandate repeal, while the bill approved by the House of Representatives does not.

Overall, Florida could see 873,000 people drop their health care coverage by 2025 if the mandate is eliminated the center estimated, according to the center. Nationally, state-by-state numbers pretty much rank the same as a state’s population size, and Florida would expect to have the third-highest number of people losing or dropping health care coverage, behind the only two states with higher populations, California and Texas.

With congressional districts, however, the variances range more widely, dependent on how many people in each district now are enrolled in Medicaid, or in health insurance policies purchased through the individuals’ market, or in insurance packages purchased through employer-sponsored plans.

The CBO projected that 5 million of those people dropping health care coverage would be dropping from Medicaid, another 5 million from the individuals’ market, and about 3 million from employer-sponsored health insurance.

“Mandate repeal has two effects on the individual market,” Emily Gee, a health economist at the Center for American Progress, explained in her report. “First, some healthy enrollees would drop out of ACA-compliant plans and become uninsured or underinsured. Second, because the remaining enrollees in the risk pool would be sicker on average, insurance companies would need to raise rates about 10 percent to cover the increased average cost. The resulting higher premiums would discourage even more people from obtaining coverage through the individual market.”

With those factors, Diaz-Balart’s district could become one of the most vulnerable in the nation to reductions in health care coverage, a phenomenon expected to not just affect individuals, but also the financial pressures on hospitals, other health care entities, and local governments, the report notes.

The center’s report says that Florida’s 25th Congressional District could expect to see 41,000 people drop or lose insurance, the fourth-highest number of any congressional district. Ros-Lehtinen’s district is projected to lose 40,800, the nation’s sixth-highest total; in Curbelo’s district, 39,900, seventh-highest among the 435 congressional districts, according to the Center for American Progress.

Diaz-Balart’s, Ros-Lehtinen’s, and Curbelo’s offices did not respond Thursday to a request from Florida Politics to comment on the center’s findings.

Several Democrats, already opposed to either version of the tax bill, responded, including Demings, whose 10th Congressional District was projected to lose 37,700 health care enrollees.

“After much debate, the facts are in: the president’s tax bill will raise your healthcare costs, putting your right to manage your own health further out of reach. Without a second thought, donors came first,” she said in a written statement. “The GOP’s proposal would mean nearly a million Floridians would lose their healthcare over the next eight years. Floridians have done their part by turning out in record numbers during the open enrollment period. However, the people seem to have been forgotten in a tax bill that was supposed to be all about the people.”

Soto, whose Florida’s 9th Congressional District in Central Florida is projected to lose about 35,400 enrollees, declared that “Florida’s hardworking families should be troubled by the current GOP Tax bill. As it stands, it is disastrous for our state’s health programs. In Central Florida alone [including his, Demings’ and Democratic U.S. Rep. Stephanie Murphy‘s districts,] approximately 103,000 people would face a reduction in health insurance coverage due to the individual mandate repeal.”

The other four Florida districts projected to be among the nation’s 50 hardest-hit nationally are Wasserman Schultz’s 23rd Congressional District in South Florida (expected to lose 37,700 health care enrollees); Hastings’ 20th Congressional District in South Florida (36,300); and Deutch’s 22nd Congressional District and Wilson’s 24th Congressional District, both in South Florida, both 35,200.

Across the country, the average congressional district would lose about 29,800 enrollees from health care plans, the center reported. Eighteen of Florida’s 27 congressional districts would exceed that average.

Stephanie Murphy CHIP reauthorization bill lining up as Democrats’ offering

With the federal Children’s Health Insurance Program and other health programs expiring, U.S. Rep. Stephanie Murphy has introduced a reauthorization bill that is becoming the Democrats’ favored vehicle facing Republican alternative measures.

On Tuesday Murphy introduced House Resolution 4541, which would reauthorize the Children’s Health Insurance Program (CHIP) community health centers funding, and other critical public health initiatives like the Special Diabetes program, the National Health Service Corps, and Family-to-Family Health Information Centers.

All of those programs had Sept. 30 reauthorization deadlines, which Congress missed.

The bill also provides funding to support the under-resourced Medicaid system in Puerto Rico and the other U.S. territories, and to support the Medicaid system in states like Florida that enroll displaced individuals from hurricane-stricken Puerto Rico and the U.S. Virgin Islands.

The cost of the bill is fully offset by modifying the timing, but not the amount, of federal payments to Medicare Advantage and Medicare Part D plans, a move supported by numerous independent experts, according to a press release issued by Murphy’s office.

“A healthy nation is a strong and resilient nation,” Murphy said in the release. “My fiscally-responsible bill provides support for children and families, invests in the prevention and treatment of serious diseases, helps our fellow U.S. citizens in Puerto Rico and other territories, and strengthens the health care systems in states like Florida that are welcoming Americans displaced by Hurricane Maria. It’s vital that we work across party lines to help the tens of millions of Americans, including millions of children, who depend on these public health initiatives.”

There are several Republican and Democratic alternatives addressing CHIP and the other health programs. Murphy’s office said her bill has become the favorite among Democrats, drawing 30 co-sponsors already, including U.S. Rep. Darren Soto of Orlando.

Murphy’s bill provides a five-year extension for CHIP, a two-year extension for community health centers funding and other expiring health care programs. It also offers equity in the Medicaid programs for Puerto Rico, the U.S. Virgin Islands and other American territories, increases the Medicaid caps for those territories, and provides increased Medicaid reimbursement funding to Florida states for providing care to individuals from Puerto Rico and the U.S. Virgin Islands who were displaced by Hurricanes Irma and Maria.

Darren Soto, Bernie Sanders pushing Puerto Rico, Virgin Islands rebuild bill

U.S. Rep. Darren Soto plans to help introduce a bill in the U.S. House of Representatives that would seek to provide comprehensive rebuilding money and resources for Puerto Rico and the U.S. Virgin Islands beyond what is needed to address just the devastation from Hurricanes Maria and Irma.

Soto, an Orlando Democrat, announced he would be joining Democratic U.S. Reps. Stacy Plaskett from the Virgin Islands, and Nydia Velázquez from New York in sponsoring the House version of a U.S. Senate bill announced late Tuesday by independent U.S. Sen. Bernie Sanders of Vermont and cosponsored by several other Democrats.

The Puerto Rico and Virgin Islands Equitable Rebuild Act, unveiled in Washington D.C. Tuesday by Sanders, Soto and the others, goes beyond just providing immediate humanitarian relief from the storms, which left the island U.S. territories in tatters, still largely without electricity and potable water more than two months later. The bill addresses longterm rebuilding of infrastructure including the schools and power systems, and equity in how the islanders are eligible for federal benefits, including Medicaid and Medicare.

It also calls for more equitable resolution of the Puerto Rico government’s $75 billion debt, now being addressed in bankruptcy proceedings, and seeks seeks to provide the additional aid without forcing the territories to take on more debt.

First, though, it calls for the federal government to immediately address the humanitarian crises by “mobilizing all necessary resources and assets to restore power, provide clean drinking water and food, safe shelter and access to health care,” according to a press release issued by Soto’s office.

“The people of Puerto Rico have been living in a nightmare for far too long,” Soto said. “We talk about power to the people. The people of Puerto Rico and Virgin Islands need power! I am proud to support this legislation that will help the islands get the lights back on and their economies going again. As we look to rebuild the islands, we have an opportunity to become an energy model for the 21st century if we invest right.”

“We will stand with the American citizens of Puerto Rico and the Virgin Islands,” Sanders said in introducing his bill Tuesday. “We will rebuild those islands better than before the disasters devastated them.”

In addition to stepped-up immediate relief, the bill calls for:

– Puerto Rico’s debt to be addressed in a way to ensure the territory can recover “with dignity” and that the recovery effort should not add additional debt.

– Replacing the “antiquated, centralized and inefficient”power systems with new grids incorporating renewable energies, including solar.

– Parity with states in benefits from Medicaid and Medicare, and equity in the amount of money available.

– Rebuilding and improving the U.S. Department of Veterans Affairs hospital and clinics.

– Improvements to public schools, colleges and childcare facilities, which the sponsors contend were “inadequate before the storms hit,” noting that hundreds of public schools were closed in Puerto Rico because of Austerity measures before the storms, and the Virgin Island schools struggled.

– Investments in infrastructure to spur economic development.

– And environmental cleanup, not just from the storms, but from prior pollution and military bombing exercises on the island of Vieques.

Florida Hospital Association lauds Stephanie Murphy’s ‘Disaster Displacement Act’

The Florida Hospital Association is expressing strong support and “deep appreciation” for a bill by U.S. Rep. Stephanie Murphy that would make Puerto Rican evacuees almost immediately eligible for full Medicaid coverage by the federal government if they have to evacuate to Florida.

The hospital association praised Murphy’s “Disaster Displacement Act of 2017,” House Resolution 4249, introduced last Friday by Murphy, a Winter Park Democrat, and co-sponsored by U.S. Rep. Darren Soto, an Orlando Democrat, and which is an identical companion to legislation introduced in the Senate by U.S. Sen. Bill Nelson, a Florida Democrat.

The bills are in response to the influx of Hurricane Maria victims evacuating the island because their homes and communities remain unlivable, and in many cases their jobs are gone. Estimates run as high as 120,000 who already have arrived in Florida, and estimates go as high as 300,000 who might eventually arrive. Many are arriving with little documentation and no insurance, relying on Medicaid for health care issues that include cancer treatment and chronic illnesses.

Murphy’s and Nelson’s bills would enroll evacuees arriving in Florida in Medicaid through an expedited process, and have federal government cover the full costs of their care for at least 24 months. In the absence of this legislation, the state of Florida would be required to pay nearly 40 percent of the cost of care, straining the state’s budget.

Nelson’s Senate Bill 2066, which, like Murphy’s was filed late last week, has already received endorsements from several local officials, including: Orlando Mayor Buddy Dyer, Osceola County Commissioner Fred Hawkins and Miami-Dade County Commissioner Daniella Levine Cava. The measure now heads to the Senate Finance Committee for consideration.

Murphy’s bill has been assigned to the House Energy and Commerce Committee, and the House Financial Services Committee.

“On behalf of the Florida Hospital Association’s over 200 organizational members, I am writing to express our strong support and deep appreciation,” FHA President Bruce Rueben wrote.

“In all cases, Florida’s hospitals will help everyone and anyone in need. The displaced residents of Puerto Rico are not exceptions. Our mission is to care for everyone and we will gladly meet this new challenge just as we stepped up to help our own communities during and after Hurricane Irma. This vital legislation will go far to help ensure that Florida’s hospitals continue to have the necessary funding to fulfill our mission to care.”

Murphy said the bill is modeled after a similar law passed to assist states such as Texas that took huge influxes of migrants displaced by Hurricane Katrina in 2005.

Her and Nelson’s bills also would allow local housing authorities to access additional federal funding to help provide housing for Puerto Rico evacuees.

“Florida is doing the right thing by taking in thousands of our fellow American citizens whose lives were uprooted as a result of Hurricane Maria, and the federal government should have our state’s back,” Murphy stated in a news release . “Just as we did after Hurricane Katrina, we should give states who receive hurricane victims the resources they need to provide for their current and new residents. Central Florida has received a significant percentage of the Americans leaving Puerto Rico, creating greater demand for health care services and quality, affordable housing

Senate moves again on health insurance changes

Physicians would have greater leeway in prescribing medications to patients, and insurance companies would have less time to approve prior-authorization requests under a bill unanimously approved by a Senate panel Tuesday.

But bill sponsor Greg Steube, a Sarasota Republican, told senators that if they would like to see the proposal (SB 98) make it into law, they need to press the House of Representatives – which, he said, killed a similar measure last year.

The bill would amend current law to require health insurers, HMOs, Medicaid managed-care plans and pharmacy benefit managers to approve or deny prior-authorization requests in urgent circumstances within 24 hours of receiving the requests. In non-urgent situations, companies would have three days.

The timelines are shorter, for example, than what’s currently allowed in the state-employee health insurance program and in the Medicaid program.

HMOs and insurance companies that participate in the state group program are contractually required to review urgent or emergency prior-authorization requests within 24 hours after receipt and within 14 calendar days after receiving routine requests.

Meanwhile, according to a staff analysis, Medicaid officials said they would have to amend managed-care contracts to change prior-authorization requirements and utilization-review timeframes.

Currently, Medicaid managed-care contracts require health plans to authorize or deny standard requests for prior authorization for services other than prescribed drugs within seven days and authorize or deny expedited requests within 48 hours.

Prior authorizations for prescription drugs must be handled more swiftly; the plans must deny, approve or seek additional information within 24 hours after receiving requests for prior authorization for prescription drugs.

According to the staff analysis, the bill would “significantly affect the business (staffing, systems, etc.) and clinical operations of the Medicaid managed care plans. The bill requires the plans to shorten the time to review authorizations, which will increase the administrative costs.”

However, the staff analysis stopped short of putting a price tag on the changes, noting that the increased costs in the Medicaid program and the state group health plan are “indeterminate.”

Groups supporting the bill include the Florida Medical Association, the Florida Osteopathic Medical Association and AARP Florida. It has widespread support in the Senate, which unanimously passed a similar proposal last year.

Senate Banking and Insurance Committee member Doug Broxson, a Gulf Breeze Republican, said he has seen similar legislation over the last several years and asked Steube: “Why didn’t it pass last year, and what would we have to do to make sure this gets on the governor’s desk this year. Where’s the hang up?”

Steube said the bill died last year in the House Health and Human Services Committee and half-jokingly told members, “I encourage you to talk to Chair (Travis) Cummings,” who leads the House committee.

Broxson, though, pressed Steube, asking him if the Senate was “positioning itself to do this every year, to vote on something that is not going to be heard in the House or be seriously considered?”

Steube then struck a serious tone, saying he’s been told Cummings, in Orange Park Republican, may be “more open to looking at it this year” but said he hadn’t had the opportunity to speak with the House chairman about the bill. The bill is filed for the 2018 legislative session, which starts in January.

In addition to addressing prior authorization requirements, the bill also would create a new section in insurance law to address “step therapy” or “fail first” protocols used by insurance companies, HMOs and pharmacy benefit managers. The protocols prescribe certain medical procedures, prescription drugs or courses of treatments that must be used to treat conditions.

Natalie Blake, director of program services for the Multiple Sclerosis Foundation, told senators that “it’s unconscionable for somebody with a disease like multiple sclerosis to have to fail a drug first. They should be allowed to take any drug that their physician approves for them that is approved,” by the Food and Drug Administration.

“In MS, if you fail a drug, it results in further disability. You have more progression of your disease and in the long run, it results in a lot more costs to the health system,” she said.

But insurers said the bill would curb the effectiveness of the protocols by requiring insurance companies to approve providers’ requests for exceptions under certain criteria. Exceptions would be required, for instance, if a treatment is expected to worsen a patient’s medical condition or decrease the ability of the patient to perform daily activities.

Audrey Brown, president of the Florida Association of Health Plans, was the sole lobbyist to speak against the bill Tuesday.

She told the panel that prior authorization and step therapy requirements serve a twofold purpose: to save costs and to ensure patient safety.

“Half of over every dollar spent by the pharmaceutical industry is on direct consumer marketing, which increases a patient’s demand for high-cost brand drugs,” she told the committee. “Requiring the step of a generic equivalent is one of the only negotiating tools a health plan has over costs.”

Brown also touched on Florida’s opioid crisis in her testimony, noting that requiring patients to take non-addictive opioid alternatives before narcotics helps curb potential overprescribing.

Republished with permission of the News Service of Florida.

Nursing home providers quarrel over quality payments

A bruising battle over how to parcel out billions in Medicaid payments for nursing homes is showing little signs of ending anytime soon.

The latest skirmish happened this week at a meeting where both sides of the tug-of-war were supposed to be trying to draw up a detailed blueprint for a revamp of how nursing homes get paid under the state-federal health care program.

The meeting devolved into a tense exchange when Scott Hopes, a nursing home lobbyist, snapped at a fellow member of the workgroup for not answering what he said was a “simple, yes or no question.”

Keith Myers, president and CEO of West Palm Beach-based MorseLife Health System, was interrupted by Hopes three times as he tried to respond.

It’s not surprising that those involved in the nursing home industry are closely watching the workgroup, since long-term care remains one of the largest expenses in the Florida’s $26 billion Medicaid program.

The state set up a nursing home prospective payment workgroup earlier this year following a contentious battle during the 2017 session over a push by some nursing homes to alter how they are reimbursed.

A prospective payment system is a reimbursement system in which rates are determined in advance of payment and considered final upon payment. Currently, the state reimburses skilled nursing facilities on a cost-based rate and rates are generally retrospective in nature.

The Florida Health Care Association pushed the Legislature to approve a prospective payment system but LeadingAge Florida said the new calculation system didn’t make quality a top priority.

The Legislature agreed to the changes but pushed back implementation to October 2018. Lawmakers also tasked the State Agency for Health Care Administration with creating a work group to, among other things, assist in the development and refinement of quality measures that should be included in the reimbursement calculations.

Workgroup members agreed at their inaugural September meeting to use, as a starting point, quality metrics included in a 2016 report published by state-hired consultant Navigant. The report provided a roadmap for transitioning from cost-based reimbursement to a fixed-fee system.

After a lengthy discussion last month, the panel agreed to keep some of the quality metrics included in the Navigant report but left pending until Thursday’s meeting action on more than a half-dozen other recommended changes.

Some of the proposed changes include eliminating incontinence and the use of restraints as metrics in the quality payment incentive but adding weight loss for consideration.

The additional time between meetings, however, didn’t help the workgroup members to reach consensus.

After 45 minutes of debate, mostly focused on whether the proposed changes would take effect in October 2018 or in 2020, the committee voted 6-5 to delete the incontinence metric, effective next year, from consideration.

But panel member Beverly Williams subsequently said she was uncomfortable with approving any changes that would take effect in October 2018.

“I’m thinking really we should kinda stay with the way it is now until such time that we’ve gone a year or so and we know what’s going on, which ones are problematic,” she said. “I think I am changing my first vote.”

Sensing that the technical advisory panel wasn’t going to be able to come to agreement, Hopes recommended that the committee approve the quality recommendations included in the 2016 Navigant report and that a subsequent panel be appointed to further analyze the quality of care metrics.

“(Is there) such strong opposition to it (the Navigant metrics) that we cannot move this meeting forward unless we change it?” Hopes asked panel members, especially Myers.

“Some of them,” said Myers. But when Myers tried to explain his position, Hopes interrupted.

“So your problems are significant enough that you are not going to be able to live with this? We have to change it?” Hopes asked Myers.

“It’s not about the organization,” Myers said, again trying to elaborate.

But Hopes interrupted Myers for a second time, asking him again whether he would agree to submitting the Navigant report or if that made him uncomfortable.

When Myers went to answer the question, Hopes interrupted him a third time.

“It’s a simple question: yes or no,” Hopes said, quickly adding, “I’m trying to move this meeting along.”

Myers noted that he also was trying to keep the group on task. He reminded Hopes that the panel last month agreed to delay action on nine proposed changes until Thursday, which was why the items appeared on the agenda.

Myers also said that creating another committee to examine the quality metrics between now and October 2018 just adds another layer of bureaucracy to the process.

But Hope told Myers that his “sense” was that the panel wouldn’t be able to come to a consensus on the nine issues Thursday.

He reiterated his recommendation that panel members be asked whether they supported submitting the recommendations in the Navigant report.

But this time it was Myers who retorted.

“Is that an agenda item, because that’s not what I’m reading,” he said.

The back and forth ended only after Interim Assistant Deputy Secretary for Medicaid Finance and Analytics Tom Wallace suggested that the panel members submit written comments to the agency.

Wallace said he wanted the technical advisory committee’s report to be a reflection of the panel’s sentiments and, to that end, asked that each member provide written comments on the nine proposed changes. The comments would be included in the final report, Wallace said.

“We could definitely do that,” he said. “We like to do that.”

The three-hour meeting at the Agency for Health Care Administration’s Tallahassee headquarters wasn’t all controversial, though.

Nursing home technical advisory panel members agreed to temporarily defer any decision on how supplemental payments for ventilators should be applied.

The panel also agreed not to apply a 2011 law that prevents rates from being adjusted for inflation when the prospective rates are being rebased.

That recommendation was made by panelist Bob Asztalos, chief lobbyist for the Florida Health Care Association, which aggressively lobbied the Legislature to pass the prospective payment system into law.

Asztalos noted that the state retooled how it paid hospitals for inpatient and outpatient care. During that transition period, hospitals were exempt from a 2011 law restricting Medicaid rates from being annually adjusted for inflation.

After the recommendation was unanimously approved, Asztalos quipped he was beginning to feel “warm and fuzzy.”

Hopes, who had been frustrated earlier in the meeting, joined in Asztalos’ optimism.

“We went from a health debate to ending our agenda with consensus,” Hopes said.

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.

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