Change of heart

Fla. gov­er­nor agrees to ex­pand Med­i­caid

Modern Healthcare - - REGIONAL NEWS - Me­lanie Evans and Beth Kutscher

Florida Gov. Rick Scott, who swiftly re­jected Med­i­caid ex­pan­sion un­der health re­form af­ter last year’s U.S. Supreme Court de­ci­sion al­lowed states to do so, called for the state to ex­pand the safety net pro­gram for three years, or as long as fed­eral tax dol­lars cover all the costs.

The Repub­li­can gov­er­nor—one of a num­ber to re­cently an­nounce they would em­brace fed­eral fi­nanc­ing for the Med­i­caid ex­pan­sion—said the state would use the time to eval­u­ate its op­tions and as­sess how the in­creased en­roll­ment af­fects health­care costs, ac­cess and qual­ity.

“It’s a com­mon-sense so­lu­tion,” Scott said in a news con­fer­ence an­nounc­ing his de­ci­sion. “It’s good for those that don’t have health­care right now, and it’s good for tax­pay­ers be­cause it’s some­thing we can af­ford to­day.”

States may ex­pand Med­i­caid un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act to those with in­come up to 138% of the fed­eral poverty thresh­old, but last June’s Supreme Court de­ci­sion on the law re­moved any penalty for states that refuse to ex­pand the pro­gram, which is jointly fi­nanced by state and fed­eral tax dol­lars.

Med­i­caid rolls could ex­pand by 7 mil­lion to 13 mil­lion in 2014, largely low-in­come adults with­out chil­dren, un­der the new el­i­gi­bil­ity rules, fed­eral of­fi­cials es­ti­mate. Roughly 3.8 mil­lion Florid­i­ans lacked in­surance in 2011, ac­cord­ing to the most-re­cent fig­ures from the U.S. Cen­sus Bureau, or about 20% of the to­tal pop­u­la­tion.

Scott called for a state law to ex­pand Med­i­caid that would ex­pire in three years, when fed­eral fi­nanc­ing for the ex­pan­sion de­clines to 95% from 100%. He also called for the law to ex­pire should fed­eral of­fi­cials fail to cover 100% of costs through 2016, as re­quired un­der the ACA. With to­tal fed­eral fi­nanc­ing, Scott said he could not “in good con­science” re­ject ex­pan­sion.

At the end of three years, Scott said the state would not “sim­ply deny” in­surance to the newly en­rolled, but did not spec­ify how cov­er­age would con­tinue. “We will eval­u­ate whether ser­vices are best pro­vided through the Med­i­caid pro­gram, if the pro­gram needs more flex­i­bil­ity, or if some ser­vices are bet­ter pro­vided in the pri­vate mar­ket,” he said.

Scott also said the state would not es­tab­lish a health in­surance ex­change, an­other ma­jor pil­lar of the law’s push to re­duce the num­ber of unin­sured. Un­der the law, fed­eral of­fi­cials must in­stead op­er­ate the ex­change, which serves as an in­surance mar­ket­place. Low­in­come house­holds may re­ceive sub­si­dies to buy in­surance in the ex­change.

Scott, a vo­cal critic of the law who pre­vi­ously re­jected Med­i­caid ex­pan­sion, said he con­tin­ued to dis­agree with the law. “It’s not an easy choice,” he said, at times sound­ing de­fen­sive. “It is not a white flag of sur­ren­der to government-run health­care.”

Scott praised fed­eral health of­fi­cials for re­cent waivers that will al­low the state to shift those cov­ered un­der Med­i­caid into man­aged-care plans.

HHS re­cently no­ti­fied the state that it would grant its re­quest for a med­i­cal as­sis­tance waiver—a de­ci­sion that comes just weeks af­ter the de­part­ment granted Florida’s first re­quest for a waiver for its long-term­care pro­gram.

The waivers al­low the state to en­roll vir­tu­ally all Med­i­caid ben­e­fi­cia­ries into the man­aged-care pro­gram, in­clud­ing el­derly and dis­abled ben­e­fi­cia­ries cur­rently in nurs­ing homes.

How­ever, HHS noted in a let­ter that the agency will work with the state’s Agency for Health Care Ad­min­is­tra­tion to en­sure a “ro­bust in­de­pen­dent con­sumer sup­port pro­gram” to help ad­dress ben­e­fi­ciary con­cerns.

Scott in a news re­lease called the waiver de­ci­sion “a great win for Florida” that will give the Med­i­caid pro­gram in­creased flex­i­bil­ity to im­prove care co­or­di­na­tion, man­age chronic con­di­tions and boost pre­ven­tive care.

Scott added in the re­lease that the goals of the man­aged-care pro­gram in­clude en­cour­ag­ing pa­tient-cen­tered care and per­sonal re­spon­si­bil­ity, pro­vid­ing fully in­te­grated care and al­low­ing new re­im­burse­ment models with an in­creased fo­cus on out­comes.

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