Medicaid

Five years after the Affordable Care Act passed, the law's provision allowing the expansion of Medicaid coverage to more people is still causing huge fights in state legislatures.

Associated Press

Florida Republican Gov. Rick Scott says he and the Obama administration are still far apart on health care financing issues that have paralyzed the state's efforts to pass a new budget.

After meeting privately with federal Health and Human Services Secretary Sylvia M. Burwell on Wednesday, Scott said the two "had a good conversation," but added, "we don't have resolution."

The Florida House has adjourned for the 2015 lawmaking session. The move comes as the legislature was gridlock over whether to expand Medicaid under the Affordable Care Act.

Wikimedia Commons

Two bills headed for Gov.

Florida Legislature

 Top Republicans in the Florida House made an offer Thursday to try to bridge a budget gap with Senate Republicans, but it could still result in the state's hospitals getting significantly less than they are receiving now.

House leaders offered to trim back spending on tax cuts and education - in order to boost spending in the state's safety net health care program. The offer, however, would be unconnected to a push by the Senate to expand Medicaid or revamp an existing program that takes federal money for hospitals.

Wilson Sayre / WLRN

 This is the third part in our series, Falling Into The Gap, in collaboration with the Miami Herald. Read more about the coverage gap and find affordable care on WLRN.org/healthgap.

Every Tuesday, a giant blue bus parks in front of the Pentecostal Tabernacle Church in Miami Gardens. Inside looks like a doctor’s office with a reclining exam chair and anatomical charts. You only know that it’s not a traditional office when it shakes as people get on and off.

Florida families may have read about a fight over Medicaid expansion in Tallahassee and how it may impact adults. Fewer have heard how the fight is jeopardizing money our state desperately needs to care for some of our sickest children.

18 month old Ana and four year old Connor McCorkle are two of the thousands of children who ended up in the middle of the battle through no fault of their own.  The children of a firefighter and a law student were born with a rare disease that affects their nerves and muscles and are treated by our neurologist, one of very few in the country.

Senate LIP Plan Added to Federal Proposal

Apr 21, 2015
Agency for Health Care Administration

The state agency responsible for Medicaid submitted a new proposal Monday to the federal government for up to $2.2 billion in health-care funding, but the move might be too late to break a budget impasse.

The new model for the Low Income Pool, or LIP, program closely follows legislation approved by the state Senate earlier this month. LIP, which is largely used to cover the expenses of uninsured, low-income Floridians who show up at hospitals needing treatment, is set to expire June 30.

Associated Press

  

Gov. Rick Scott said Thursday he is suing the Obama administration for withholding hospital funds because the state won't expand Medicaid.

The announcement is another twist in what has been a gritty yearlong battle with the feds over roughly $1 billion in funds for Florida hospitals that serve low-income people. The fight has come to a head as the state Legislature is desperate for an answer from the feds so it can finalize a state budget before May 1.

Daylina Miller/WUSF

Mike Fernandez's made billions building health care companies and he is not happy with the governor's stance on Medicaid expansion.

He said  Gov. Rick Scott is wrong to not want federal money that would expand health insurance to poor Floridians.

House Republicans quietly deepened recommended budget savings from the government's chief health care program for the poor by about $140 billion in recent weeks to offset part of the cost of higher payments to doctors who treat Medicare patients, according to officials familiar with the tradeoff.

The maneuver comes as Republicans in both houses struggle with competing priorities, in this case a desire to stabilize what is widely viewed as a dysfunctional system of provider payments under Medicare, while pursuing a 10-year goal of balancing the budget.

Health Expansion, LIP Program Divide Budget Proposals

Mar 19, 2015

In a move that creates a $5 billion divide with the House, the Senate released a budget proposal Thursday that banks on expanding health-care coverage for low-income Floridians and extending a critical funding program for hospitals.

The Senate proposal, approved by a key budget panel and touted by President Andy Gardiner, reinforces that health-care funding could be the most-vexing issue facing lawmakers during the rest of this year's legislative session.

The Florida Senate is working on bills that would increase the amount of federal Medicaid money used to fund mental health and substance abuse problems, Florida Politics reports. The Senate Appropriations Subcommittee on Health and Human Services will discuss the bill drafts Monday at its meeting.

House Panel Blocks Medicaid Dental Changes

Mar 11, 2015
Dave Buchwald

A House panel Tuesday rejected a proposal to revamp the Medicaid program's system of providing dental services to children.

The House Health Innovation Subcommittee deadlocked 6-6 on the proposal (HB 601), filed by Rep. MaryLynn Magar, R-Tequesta. A tie kills a bill. 

Under the state's new Medicaid managed-care system, HMOs and other types of managed-care plans are responsible for providing dental services to children.

Federal authorities haven’t publicly accused taxpayer supported Broward Health of submitting bogus claims to Medicare and Medicaid, but the health system still has racked up a $10.2 million tab for legal advice, the Florida Bulldog reports.

Wikimedia Commons

Some foster children are not getting their required medical screenings even though the visits are paid for by Medicaid, federal health investigators warn in a study released Monday.

The Health and Human Services' inspector general study looked at a random sample of roughly 400 foster children from California, Texas, New York and Illinois and found nearly 30 percent did not receive one or more of their required health screenings between 2011 and 2012.

HealthCare.gov

The share of Americans without health insurance dropped to its lowest level in seven years in 2014 as President Barack Obama's overhaul took full effect, according to an extensive survey released Tuesday.

The Gallup-Healthways Well-Being Index found that the trend appears likely to continue this year, since 55 percent of those who remained uninsured told the pollster they plan to get coverage rather than face escalating tax penalties.

In Florida, the rate dropped 3.4 points.

Senate Health Panel Tries Again on Telemedicine

Feb 4, 2015
Florida Senate

Pointing to a need to increase access to health care in areas such as rural communities, a bipartisan group of House and Senate leaders Tuesday expressed confidence they will reach agreement this year on a plan to boost the use of telemedicine in Florida.

Sometimes called "telehealth," telemedicine involves using the Internet and other technology to provide care to patients remotely.

As a basic example, a physician could use a video link to consult with a patient who is at home.

Disputes About Old Hospital Rates Stir Controversy

Feb 3, 2015

  A Senate committee Tuesday postponed taking action on a controversial bill that stems from disputes about old Medicaid payment rates for hospitals.

The bill (SB 322), filed by state Sen. Kelli Stargel, R-Lakeland, would create a five-year time limit on challenges by hospitals to reimbursement rates. Supporters of the bill said it is needed because some hospitals have filed administrative challenges to reimbursements that date back to the 1990s or earlier.

FL Negotiates For LIP Money Amid Questions

Feb 3, 2015
Agency for Health Care Administration

 Florida's Medicaid director met Tuesday with federal officials as the state tries to continue receiving $1 billion a year to help hospitals and other providers care for low-income and uninsured people. Justin Senior, a deputy secretary at the state Agency for Health Care Administration, traveled to Baltimore to meet with federal officials about what is known as the Low Income Pool, or "LIP," program.

Centers for Disease Control and Prevention

Caring for Alzheimer’s and dementia patients is emotionally demanding but also is increasingly expensive, according to a Fort Myers News-Press analysis of 10 years of records from state agencies, nursing homes and hospitals.

A new health-care policy plan from the Florida Chamber of Commerce backs an expansion of health coverage under an alternative to Medicaid expansion, the Florida Times-Union reports. The chamber president says they “largely agree" with the "A Healthy Florida Works” plan backed by several Florida business groups.

Agency for Health Care Administration Secretary Elizabeth "Liz" Dudek has an ambitious "to-do" list for Governor Rick Scott's upcoming second term, according to Christine Jordan Sexton of SaintPetersblog

WellCare Health Plans

WellCare Health Plans, Inc., Florida’s largest Medicaid HMO provider, announced Monday that Kenneth Burdick will be appointed as CEO, according to a statement released by the Tampa-based company. 

Burdick, who previously served as the company’s president and chief operating officer, will be replacing interim CEO David J. Gallitano Jan. 1.

According to the statement, Burdick has previously held executive positions with companies such as Blue Cross Blue Shield, Coventry Health Care, and UnitedHealth Group.

St. John's County

Former employees of a medical clinic accuse the St. Johns County Commissioner and his mother of improperly billing for nearly 40 Medicaid patients, illegally storing controlled substances and forging prescriptions, the Florida Times-Union reports. 

Governor Rick Scott is reappointing Elizabeth Dudek to oversee the Florida Agency for Health Care Administration.

Dudek has been the head of the agency since 2011. Together, they helped privatize the Medicaid program, paying private insurance companies a set fee for roughly 3 million Medicaid recipients instead of the state paying for each service patients incur.

Scott also praised Dudek for overseeing that Florida hospitals were prepared for Ebola.

The veteran business executive hired by Florida Healthcare Plus is trying to repair the image of the firm after six former employees were indicted for their role in an international, $25 million Medicare and Medicaid scam, the Miami Herald reports.

In an interview, Susan Rawlings Molina says no one else at the company knew about the fraud, except for the ex-employees who are now facing charges. Only the former workers, not the company, are accused of wrongdoing.

U.S. Health Spending Growth Lowest Since 1960

Dec 4, 2014

National health spending grew 3.6 percent in 2013, the lowest annual increase since the Centers for Medicare and Medicaid Services (CMS) began tracking the statistic in 1960, officials said Wednesday.

Spending slowed for private health insurance, Medicare, hospitals, physicians and clinical services and out-of-pocket spending by consumers.  However, it accelerated for Medicaid and for prescription drugs, according to the report, published online by the journal Health Affairs.

A whistleblower’s lawsuit by an ex-Plaza Health Network executive alleges that false claims were submitted to Medicare and Medicaid to the tune of $130 million, the Broward Bulldog reports.

Sarasota Memorial Hospital will no longer be an in-network hospital for patients signed up with the region’s largest Medicaid provider, according to the Sarasota Herald-Tribune.

After Dec. 31, Staywell Wellcare patients will not be covered at Sarasota Memorial, which currently treats 90 percent of the area’s Medicaid patients who need hospital care.

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