Senate Starts Medicaid Expansion Talks With Two...Maybe Three Plans Already On The Table

Mar 4, 2015

Indiana health officials talk Medicaid expansion via video conferencing.
Credit The Florida Channel / The Florida Channel

With a potential $1 billion budget hole looming, the Florida Senate is starting to consider whether and how to accept federal funds to expand Medicaid. There are at least two proposed bills floating around the chamber, and lawmakers are also raising the possibility of resurrecting the original plan, dubbed NegronCare.

Governor Rick Scott is urging the federal government to continue funding the low-income Pool, a billion-dollar program that reimburses hospitals for treating uninsured patients. But the federal government is ready to let the program expire, says state Medicaid Secretary Justin Senior.

”The federal government has expressed to us a reluctance to continue to fund the portion of the low-income pool associated with uncompensated care delivered to people who would be picked up in a Medicaid expansion," he says.

Senior says the state may not lose the $1 billion—closer to $2 billion when state matching funds are added. The impending loss of those dollars has lawmakers grappling with how to fill in the gap. And one way to do it is by accepting federal funds tied to the Affordable Care Act—to expand Medicaid. The Senate has expressed interest before in allowing more people into the program, and is encouraged by Indiana, which recently won approval for a Medicaid expansion that includes premiums and co-pays.

Indiana officials crackled over the Senate Health committee’s video system as they discussed a two-year process of negotiations with the federal government to get the Healthy Indiana plan approved. Local Businesses and other health providers have joined together in Florida to make a stand for expansion. Tallahassee-based Marpan Recycling owner Kim Williams is part of the effort.

“A healthy workforce, a healthy business and a healthy economy area are intertwined and all add up to equal healthy state. I think we can all agree a healthy Florida works, which is the name of the coalition I stand with today," he told members of the Senate Health Policy Committee.

A Healthy Florida Works is the result of the group’s efforts and it’s currently shopping for a sponsor. It calls for the Medicaid expansion to be administered by a private vendor and for premiums to be based on income. Meanwhile the Florida Chamber of Commerce has a 49-page draft bill outlining how the Chamber would expand Medicaid, while also restructuring the rest of the state’s healthcare delivery system says Florida Chamber CEO Mark Wilson:

“Harnessing innovation and healthcare capacity. I think everyone is familiar with the work you’ve done in telemedicine, and we support that. Also professional capacity, and...medical residencies—we have that outlined in our draft as well.”

But not everyone is welcoming Medicaid expansion with open arms. The House remains reluctant to take up the issue, and Sal Nuzzo, Vice President of Policy for the free-market based James Madison Institute, says the chamber has good reason to be distrustful of the federal government.

“Funding for Florida’s low-income pool…is in jeopardy," he reminded committee members.  And if they cannot be trusted to extend a program that insures poor and low-income Floridians, how then can anyone conclude that we should trust the federal government is going to cover the cost of Medicaid Expansion?”  

The House’s reluctance has foiled Medicaid expansion for two years now. In 2013 Stuart Republican Senator Joe Negron came up with a proposal to pull down the federal funds and steer the expansion population—mostly low-income single adults—into private plans. State Medicaid Secretary Justin Senior says that plan could have gotten federal approval.