The federal government says talks between it at the State of Florida over the future of healthcare are still on. Discord over the future of Florida's healthcare system reigns as the federal government, Florida House and Senate haggle over billions in healthcare funding. And with a month left until the state legislature adjourns, all sides are digging in on their positions.
The Florida House approved its 2015-2016 spending proposal Thursda without plans to use federal dollars to expand healthcare, or to supplement hospitals treating low-income patients. Florida's federal LIP Pool funding expires this summer, and the House remains opposed to drawing down Medicaid money to insure more than 800,000 uninsured Floridians.
The stalemate took on an even darker tone Wednesday evening when the state's Agency For Healthcare Administration announced the federal government had abruptly ceased negotiations over a possible renewal of the LIP pool funding. In a statement, AHCA said it learned the federal government's chief negotiator would be unavailable for two weeks. AHCA Secretary Liz Dudek said, "for CMS to discontinue LIP negotiations now is troubling and could signal the abrupt end of this federal healthcare program in Florida."
The news shocked lawmakers, especially in the Senate. The chamber has drafted an $80 billion spending plan that relies on the federal LIP pool funding as well as using Medicaid dollars to expand healthcare to about 800,000 uninsured Floridians. Neither program is in the proposal passed by the House, something disappointing Democratic representatives.
"This chamber is alone on an island all by its lonesome," said Rep. Evan Jenne. "We're alone out here."
By Thursday one Medicaid expert was calling Florida's version of events wrong. Georgetown University Medicaid expert Joan Alker says the federal government's chief negotiator was on a previously-planned vacation for Passover, and she accused the state of misleading the public about the negotiations.
"The federal government would not walk away from negotiating on the Low-Income pool. It’s a critically important issue," Alker said. "The feds have indicated things will have to change there, but I certainly wouldn’t expect them to walk away from the table.”
Later in the day, the Federal Centers for Medicare and Medicaid Services issued its own stating refuting AHCA's version of what occurred:
“CMS has not stopped conversations with the state of Florida. CMS remains in contact with state officials and continues to share information. Senior officials from CMS will continue conversations with state officials about our shared goal of securing access to high quality health care coverage for low income Floridians. As we have previously said, CMS will not extend Florida’s Low Income Pool in its current form beyond June 30, 2015.”
In response to a question about whether it knew the negotiator was on vacation at the time AHCA said, "after months of continuing discussions, we were suddenly told Eliot Fishman would be on vacation for two weeks. When we asked to meet with the CMS Director, CMS said she would be on vacation too.”
But the agency failed to tell that to Senate President Andy Gardiner who, through a spokeswoman, said he learned about the vacation through news reports from today.
To be clear, talks are still postponed for two weeks. That means Florida won't have an answer to a pressing budget problem until near the end of the legislative session.
The Senate and the House are doubling down on their positions for and against using federal healthcare money.
Gardiner said Wednesday evening following passage of the Senate's budget, "the Senate believes it has done everything possible to advance solutions to the health care challenges facing Florida. The time has come to find common ground and present a unified solution that is best for Floridians. We hope others will join us at the table to discuss a way forward.”
But Thursday, after clearing it's proposal, House Appropriations Chairman Richard Corcoran bluntly stated a Medicaid expansion is a no-go in his chamber. Senate President Steve Crisafulli backed him up.
"We've been set there since day one. That's not a surprise to the Senate. The Senate didn't come out with this plan until the second week of session. There was never any conversations before that leading up," Crisafulli said.
The Speaker says in regard to the suspension in talks, "it was a surprise to the Secretary and the Governor and we look forward to the dialogue that they say they're still having with us." The "they" referring to the federal government. The House does not believe the LIP program and Medicaid are tied together, and has tried to de-couple the two in its discussions.
Update 4/2/2015: 4:00 p.m.: Florida healthcare officials knew federal negotiators were going on vacation when they released a statement Wednesday evening saying talks with the federal government had been, “discontinued.” The news sent state lawmakers reeling.
In a statement, the Florida Agency for Healthcare Administration says, "after months of continuing discussions, we were suddenly told Eliot Fishman would be on vacation for two weeks. When we asked to meet with the CMS Director, CMS said she would be on vacation too.”
That information wasn't included in a statement by ACHA Secretary Liz Dudek announcing an abrupt stop to negotiations over an extension of the state's Low-Income Pool funding. Georgetown University’s Joan Alker initially noted the missing information.
“More importantly, the federal government would not walk away from negotiating on the Low-Income pool. It’s a critically important issue," Alker said. "The feds have indicated things will have to change there, but I certainly wouldn’t expect them to walk away from the table.”
Alker says the state has known the Low-Income Pool program was in jeopardy.
“It was very clear there were issues, but the state has continued to maintain that everything will be fine and they’ll get the same amount of money. And I just don’t think that’s right."
A spokeswoman for the Senate President says he did not know the details until reading about them in news reports. The federal government has made clear it won’t renew the Low-Income Pool program if Florida doesn’t expand health care. It’s a contentious issue between Senators ready to expand Medicaid and House members who are opposed.
Update 4/2/2015: Georgetown University's Joan Alker, an expert on Medicaid, says talks between Florida and the federal government have not broken down. In a series of tweets, Alker says the person in charge of negotiations is on vacation during Passover. Read more from the Jacksonville Times-Union's Tia Mitchell here.
The Federal Centers for Medicare and Medicaid Services abruptly cut of talks with Florida officials over a renewal of a billion-dollar pot of money for hospitals that treat large numbers of low-income patients. The Senate's budget proposal depends on the state getting the Low-Income Pool (LIP) funding, and the two-week delay could mean budget negotiations between the House and Senate are on pause.
Florida's Agency for Health Care Administration Secretary Liz Dudek announced the move yesterday evening in a statement.
“We were informed late yesterday by CMS that their lead official discussing the continuation of the federal LIP program in Florida, Eliot Fishman, will not be available for any further negotiations for at least two weeks. This was sudden and disappointing news. AHCA’s conversations with CMS had been productive and positive until this point. For CMS to discontinue LIP negotiations now is troubling and could signal the abrupt end of this federal healthcare program in Florida."
The announcement, sent at 6 p.m. Wednesday, followed comments by Senate leaders that a recent visit to Washington D.C. had been productive. Republican Senator Rene Garcia said talks had been, "positive".
The Senate is also banking on a plan to expand Medicaid, and has included both LIP money and federal Medicaid dollars in its $80 billion budget proposal. The House, which has opposed Medicaid, and expressed doubts about whether the LIP funding will be renewed, did not include either pot of money in its much-smaller, $76.2 billion spending plan. The Senate approved its budget proposal yesterday, the House will vote on its plan today.
Check back later on for more updates to this story.