No Progress in Florida Hospital Aid Talks, as Deadline Looms

Health and Human Services Secretary Sylvia Mathews Burwell yesterday rejected Governor Rick Scott's proposal to extend the current funding mechanism, which this year brought $1.3 billion in federal funds to hospitals that care for high numbers of uninsured patients.
Published Online: May 07, 2015
Mary K. Caffrey
US Health and Human Services (HHS) Secretary Sylvia Mathews Burwell yesterday rebuffed Florida Governor Rick Scott’s plan for the federal government to keep sending more than $1 billion a year to care for the uninsured, escalating the showdown that threatens both Florida’s budget and its ability to deliver healthcare.

Scott’s visit to Washington, DC, comes after he sued the Obama Administration in a quest to retain funding for the Low-Income Pool (LIP). In Florida, the LIP provides $2.2 billion in federal and state dollars to those hospitals that care for high numbers of uninsured and underinsured patients. Florida is the first of several states scheduled to see the federal portion of these dollars lapse under deadlines spelled out long ago, as HHS seeks to prod more states to cover the poor through Medicaid expansion.

With the federal LIP portion set to run out June 30, 2015, the impasse has divided Republicans in Florida’s legislature; Senate leaders supporting Medicaid expansion while the House remains opposed. According to the Miami Herald, legislative leaders agreed yesterday to a special session from June 1 to June 20, to allow time for Scott to reach an agreement with federal health officials.

When it passed in 2010, the Affordable Care Act (ACA) envisioned states extending Medicaid to all households earning between 100% and 138% of the federal poverty line. But the US Supreme Court’s 2012 ruling that states could decide on their own whether to expand Medicaid paved the way for the current showdown. The ruling did not address whether HHS could be forced to keep funding more traditional programs to care for the uninsured.

In one corner are Burwell and leaders from the Centers for Medicare and Medicaid Services (CMS), who argue that Medicaid expansion is a more efficient way to care for this population; giving consumers insurance would encourage more of them to seek primary care and avoid expensive visits to the emergency room. On the other side is Florida’s Scott, a former hospital executive who at one time supported expansion, but now wants no part of federal funding that can be called “Obamacare.”

HHS issued a statement yesterday that Scott’s extension plan “falls short” of agency goals for providing healthcare to Florida’s 800,000 uninsured residents. Obama Administration officials also note that Florida received a 1-year extension last year—while Scott faced re-election—and state officials should have planned for these funds to expire.

Scott, for his part, said that Burwell confirmed her agency could not compel Florida to expand Medicaid.

Watching closely are healthcare officials in Texas and other states who have similar cost-sharing arrangements that are scheduled to phase out over the next 18 months. In Texas, a 5-year plan that includes funds for hospitals caring for the uninsured runs out in September 2016.

One Florida legislator who support expansion yesterday accused Scott of “rewriting history.”

“The low-income families in our state haven’t been waiting on the federal government, Governor Scott, they’ve been waiting on you,” said Florida Senate Democratic Leader Arthenia Joyner.

Around the Web

States watching Medicaid standoff between Florida, Obama
Governor Rick Scott talks with feds over healthcare funding crisis, and comes up empty
Two Tales of Medicaid Expansion: in Montana a Step Forward; in Florida, a Step Back


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