Florida And Feds Try To Work Out Medicaid Deal

The Florida Senate is doing what everyone expects legislatures to do and that is craft laws aimed at helping their constituents. They have a plan to continue receiving federal money to pay for healthcare for low-income people.

Thus far 22 states led by Republican governors have rejected Obamacare’s offer of expanded Medicaid, and the federal funds that accompany it. The health care law allows for those earning up to 133 percent of the federal poverty level to enroll in Medicaid, but the Supreme Court has said states can opt out of the expansion if they want to — and many Republican-led states have done so.

Meanwhile, the state of Florida is working with the Obama administration to craft a plan to get their share of the Medicaid money. The proposal involves restructuring what’s called the Low Income Pool, also known as LIP. The idea is to distribute federal money more broadly, benefiting more hospitals that treat a high number of poor and uninsured patients.

Florida will lose more than $2 billion in funding starting in July if the federal government doesn’t accept the new plan. Make no mistake about it the Florida Senate knows the state needs the money from the federal government and while some ultra conservative lawmakers would rather go swimming in alligator invested water than accept the Medicaid money from the Obama administration, doing so would lead to catastrophic results for some Floridians.

Right now the House and Senate have some big differences in their proposed budgets. The biggest difference is a $5-billion gap regarding healthcare costs. Senate budget chief Tom Lee told senators, media and whoever would listen that they’ve been dealt a difficult hand.

“We have a substantial healthcare funding problem in the form of a stalemate on this Low Income Pool that is so important to help our safety net hospitals and hospitals … in our state deal with the unreimbursed care.”

Meanwhile, in the Florida House of Representatives where less thoughtful legislators reside, their leaders say they want the LIP program to continue, but Lee noted they haven’t included the funds in their budget proposal.

“We do have an obligation to recognize that funding gap, the … hundreds of millions of dollars that our safety net hospitals will lose back in our communities. We cannot ignore that.”

South Florida is especially vulnerable to the loss. Sen. Rene Garcia, R-Hialeah, just got back from a trip to Washington for a meeting with federal health officials. Members of the Obama administration are willing to work with the state to get them money but in the end they will be taking the Medicaid money on the Feds terms.

 “When some folks say ‘well, what’s the big deal with LIP? What’s the big deal? These are federal dollars that are flowing through.’  To two counties in this state – our friends in Broward and our friends in Miami-Dade County, this could cost us collectively $500 million if we don’t get this LIP model approved.”

The Senate also wants to use nearly $3 billion in federal money available under the Affordable Care Act for an alternative to Medicaid expansion.  The funds would be used to create the state-run Florida Health Insurance Affordability Exchange. It would offer private market insurance at a low cost for those who meet certain work and educational requirements.

Garcia says nearly a million low income residents who don’t qualify for Medicaid would be insured.

“That fix revolves around making sure that individuals under 133 percent of the poverty line have access to affordable health insurance through our model.”

The LIP renewal may hinge on whether Florida enacts some sort of Medicaid expansion. But House leaders say they won’t consider any plan that might put more people into what they say is a broken Medicaid system.

This near sighted action from the Florida House will affect millions of Floridians and if lawmakers don’t agree on a solution for both LIP and for Medicaid, Garcia says they have three choices: cut local services, close some hospitals, or increase taxes.

Back over at the Senate at the adult table, Sen. Garrett Richter, R-Naples, also made the trip to Washington to meet with health officials. He told a press briefing this week that the funding problem isn’t going to solve itself if the state does not strike a deal with the federal government.

“My takeaway on that meeting was that we still have a serious issue to resolve, that our federal partners are going to keep an open mind. They understand that the Senate is pursuing a responsible solution.”

Senate President Andy Gardiner requested the meetings in Washington. He says Florida’s healthcare crisis is the driving force behind the Legislature’s budget decisions. He also spoke to the media this week about what is at stake if Florida does not come out of this session with deal with the Feds.

“Nobody can ever say the Senate didn’t offer up solutions. Nobody can ever say we weren’t prepared to go to the table and negotiate a modified LIP model or negotiate a free market approach to Medicaid expansion. If we’re going to make decisions on taxes, education spending, it’s important that we address the $2.2 billion hole in our budget.”


The Senate unanimously approved its budget proposal Wednesday. A few hours later – in a surprise move – lawmakers learned that the federal government has suspended negotiations with Florida health officials for at least two weeks.

Sources in Washington tell News Talk Florida that federal government is still open to a deal but they felt that the Florida Senate could use some help to bring the House along. This is not a game and the Senate has a real blue print that the House needs to follow.

Some GOP governors including New Jersey Gov. Chris Christie have accepted the expansion, but other Republicans have insisted the federal government might suddenly retract the extra Medicaid dollars, leaving states with the bill.

I will give the final word on this issue for now to the folks in Tennessee where they are attempting to do what Florida is working on – deal with the administration.

“If they [the Tennessee legislature] throw away four and a half billion dollars because they hate Obama, that’s a rather sorry tale for the leadership and the legislature, because we’ve got bipartisan support,” said Walter Davis, executive director for the Tennessee Health Care Campaign.

Mr. Davis is a wise man and the voters of the state of Florida need to make sure the Senate gets the help they need to get the House on board. The stakes are too high for partisan politics to get in the way of responsible legislative work being done by the Senate.


Jim Williams is the Washington Bureau Chief, Digital Director as well as the Director of Special Projects for Genesis Communications. He is starting his third year as part of the team. This is Williams 40th year in the media business, and in that time he has served in a number of capacities. He is a seven time Emmy Award winning television producer, director, writer and executive. He has developed four regional sports networks, directed over 2,000 live sporting events including basketball, football, baseball hockey, soccer and even polo to name a few sports. Major events include three Olympic Games, two World Cups, two World Series, six NBA Playoffs, four Stanley Cup Playoffs, four NCAA Men’s National Basketball Championship Tournaments (March Madness), two Super Bowl and over a dozen college bowl games. On the entertainment side Williams was involved s and directed over 500 concerts for Showtime, Pay Per View and MTV Networks.