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Memo Raises Possibility Of Medicaid Exit

Elderly patient holds prescription pill bottle.
Heidi de Marco/KHN
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

A high-ranking legislative staff member has warned that a proposed constitutional amendment to expand Medicaid could forever lock Florida into the safety-net health care program, taking away the Legislature’s option to walk away from it. 

The warning was circulated internally among the top staff of House Speaker Jose Oliva and turned over to state economists weighing the costs of the proposed amendment, which would expand Medicaid eligibility to uninsured childless adults.

Obtained by The News Service of Florida, the memorandum suggests the possibility Florida could end participation in Medicaid, a joint federal-state program that currently costs about $28.4 billion and provides health coverage for nearly 3.93 million poor, elderly and disabled people.

“The Florida Constitution confers upon the Legislature the authority to make policy and appropriate funds. Currently, the Legislature may choose to participate in the federal Medicaid program --- and appropriate funds to that effect --- or not. The proposed amendment appears to remove that authority, instead requiring the Legislature to enact policies --- and make appropriations --- that allow Florida to continue participating in Medicaid to ensure Medicaid benefits for the proposed expansion population,” Christa Calamas, staff director of the House Health and Human Services Committee, wrote in a July 26 memo to Oliva’s chief of staff, Carol Gormley.

Calamas described the memorandum as some “preliminary thoughts” and noted that they were requested by Gormley.

“While this memorandum is not a complete listing or treatment of the implementation issues that may arise from the proposed amendment,” Calamas wrote, “it may deserve consideration in the process of establishing economic and fiscal impacts.”

Calamas was referring to the mandated review of the proposed constitutional amendment by a panel of economists that meets as the state Financial Impact Estimating Conference. At the behest of the House, the panel is now required to review the impact of citizens’ ballot initiatives for their potential impacts on the state budget and overall economy.

The panel was scheduled to complete its analysis of the proposed Medicaid expansion amendment by July 29.

After it became clear that the panel wouldn’t be able to make that deadline, Amy Baker, who heads the Legislature’s Office of Economic and Demographic Research, agreed to extend the deadline until Monday.

But panel members still weren’t able to reach accord, and Baker agreed to extend the deadline until Tuesday.

In a statement Tuesday to the News Service, a House spokesman said the chamber has no plans to withdraw from Medicaid.

“The only point that part of the memo was making was that if ‘Medicaid’ as a program became part of the Florida Constitution, Florida would lose all flexibility and be required by the supreme governing document of the state to remain in whatever the federal government deemed to be ‘Medicaid,’” spokesman Fred Piccolo said. “Florida would simply have to accept everything Washington D.C. piled into the program.”

In Medicaid, the federal government sets minimum mandatory benefits, or entitlements. States can, and do, add optional benefits.

As part of the federal Affordable Care Act, Washington mandated Medicaid coverage for low-income childless adults earning up to 138 percent of the federal poverty level. Under the law, commonly referred to as Obamacare, states that didn’t carry out the expansion would lose all federal Medicaid funds.

But the U.S. Supreme Court rejected the requirement, finding that punishing states that didn’t expand Medicaid was coercive and violated federal law.

The ruling effectively made expanding Medicaid to childless working adults optional for states. Thirty-six states and the District of Columbia have expanded Medicaid access, according to the advocacy group Families USA.

But the Republican-led Florida Legislature, has been steadfast in its opposition to expansion.

The proposed constitutional amendment could allow supporters to take the issue directly to voters and effectively bypass the Legislature.

But the amendment drive may be pushed back two years, as organizers try to figure out if they can muster the resources to put the issue on the 2020 ballot. To date, they have submitted a fraction of the petition signatures needed to get the measure on the ballot.

But they have gathered enough signatures to trigger reviews by the Financial Impact Estimating Conference and the Florida Supreme Court.

A spokesman for the political committee backing the proposed constitutional amendment didn’t immediately reply to a request for comment Tuesday.