Last year, the state and counties sparred over disputed Medicaid bills. Medicaid is a federal, state and local program that provides low-income people with insurance. The state backed down and settled for far less than it felt was owed. But now, the Florida legislature is revamping the way the county share of Medicaid is calculated, and critics say the new formula will lead some counties to pay more, and others to pay less.
First, rewind to 2012. By the start of that year Florida counties had racked up an estimated $370 million in unpaid Medicaid bills for people in nursing homes and hospitals. The state was cast in the role of annoying debt collector, after the legislature passed a bill forcing the counties to pay up. The counties responded with, “prove it.”
“A backlog of that started at $370 million was reduced to $168 million because they realized that many of the bills were, in fact, unverifiable," said Cragin Mosteller, spokeswoman for the Florida League of Counties.
She says Florida’s Agency for Healthcare Administration had double-billed the counties. The bills accumulated over the course of a decade, with the state never addressing billing disputes. Counties ended up paying far less than what the state said they owed. In the case of St. Johns County, a million dollar Medicaid bill was settled for a quarter of that amount.
Counties are responsible for a portion of the Medicaid costs of the people who live in them, but Mosteller says the counties were being charged for people who didn’t live there.
“The addresses entered into the system are entered in by the Medicaid recipients themselves, so sometimes it’s simple human error. There were also computing errors, and the computer didn’t recognize that zip codes cross county lines. It’s been fixed, but one county may be billed for residents that lived in another county.”
The legislature is now tinkering with that billing system. The Senate wants to base county Medicaid charges on the percent of eligible recipients in the counties, instead of the people actually using the services. Critics say the change would create winners and losers. Central Florida’s tiny, rural Hardee County would end up on the losing side.
“We’d have a 103 percent increase. One of the highest in the state. We feel we’re being swallowed up by healthcare. Our millage is at 8.55. We have no wiggle room, and we already operate under a shoe-string budget," said Hardee County Commissioner Sue Birge.
Hardee’s 27,000 residents are expected to pay $276,000 dollars in Medicaid costs this year. The Senate proposal would phase in the changes over seven years. At the end of that time, Hardee’s Medicaid bills would grow to be more than $760,000 thousand, putting the squeeze on local taxpayers. Meanwhile, counties like Pinellas, with its large population of seniors on Medicare, would see costs for treating low-income people on Medicaid fall from $16 million to $14 million. That’s because smaller and more urban counties tend to have more low-income, Medicaid-eligible Floridians. But bill sponsor Republican Senator Denise Grimsley, whose district includes Hardee, says basing the system on the number of people enrolled in Medicaid is the only fair solution:
“For instance, Small County A is probably using large County A for healthcare. So the only fair way to charge the county is per-enrollee, because each county is responsible for each Medicaid enrollee,” she said earlier in the week in a hearing before the Senate's Appropriations Committee.
Grimsley’s Senate Bill 1884 is heads to the Senate floor. Counties say they hope changes will be made to make the system more equitable. If not, it could set the stage for more billing battles in the future.
