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Florida Governor Drops Support of Medicaid Expansion

By Rebecca Adams, CQ Roll Call

April 6, 2015 --- Republican Gov. Rick Scott is reversing his support for expanding Medicaid coverage to 800,000 residents in Florida, and blamed his change of heart on what he said were failed negotiations with federal officials over the U.S. funding for so-called safety-net hospitals that provide care for indigent and uninsured patients.

Difficulty in the safety-net, or low-income pool, hospital talks, he said, led him to agree with other Republican governors and lawmakers who say that one reason they oppose expanding Medicaid in their states under the 2010 health care law is that they don’t believe the federal government will continue to pay for at least 90 percent of the cost of expansion.

Under the federal law, state Medicaid programs can be expanded to enrollees with incomes up to 138 percent of the federal poverty line. The expansion's cost in the state is 100 percent covered by the federal government through 2016. Federal support phases down until states that expanded will be responsible for 10 percent of the cost starting in 2020. Twenty-eight states and the District of Columbia are participating in the expansion.

"Our priority is to cut more than $600 million in taxes this session and get K–12 education funding up to record levels while holding the line on college tuition," Scott said in an e-mailed statement. "We still have several weeks left for budget negotiations; however, given that the federal government said they would not fund the federal [Low Income Pool] program to the level it is funded today, it would be hard to understand how the state could take on even more federal programs that [the Centers for Medicare and Medicaid Services] could scale back or walk away from."

Florida senators have advanced a bill that would allow the state to accept $51 billion from the federal government to add more Floridians to the Medicaid rolls. The state has been closely watched for Medicaid expansion because it has one of the largest uninsured populations in the country.

State lawmakers have reconsidered expansion plans this legislative session as federal funding for their state safety-net hospitals under the Low Income Pool is slated to end June 30.

CMS extended the Low Income Pool program last year as part of the renewal of Florida’s Managed Medical Assistance Program. The one-year extension was meant to give providers stability as the state transitioned to statewide managed care.

Lawmakers planned to allocate $1.3 billion from the Medicaid expansion funding toward the safety-net hospitals if federal officials denied funding. Scott and federal officials were negotiating to keep that federal funding in place. Florida officials say those talks have recently come to a halt. CMS officials say that those talks haven’t stopped.

Ben Wakana, press secretary for the U.S. Department of Health and Human Services said in an e-mail statement that the health law has made it clear that federal funding "will never fall below 90 percent."

"HHS has proven itself willing to work with any state interested in expanding Medicaid, and we have consistently said that a Florida solution would reduce costs for hospitals that are typically passed on to taxpayers and expand access to quality health care for more Floridians," Wakana said. "That’s a common sense path that’s good for taxpayers and the economy of the Sunshine state."

Scott’s announcement could also ruin budget talks between the House and Senate. House members have refused to include Medicaid expansion as part of their budget proposal, making looming reconciliation talks an uphill battle. The two chambers’ budgets are $4.2 billion apart.

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