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Feds to FL: We're Flexible; Show Us Your Plan

Medicaid expansion for 1 million low-income adults in Florida may technically be dead, after committees in both the House and Senate voted to kill it. And yet, chances for an alternative plan that would accomplish the same goals are looking up.

On Wednesday, federal health officials  signaled interest in seeing Florida’s alternative plan, which is still just a  gleam in the eye of a powerful state senator, as soon as the state has something in writing.

And a report on how much it would cost the state to offer coverage in private plans to the newly insured estimated that it would cost  3 percent to 4 percent less than for the current Medicaid population.

Even House Speaker Will Weatherford, a vocal opponent of Medicaid expansion, moderated his tone somewhat in speaking to reporters this week.

“We’re very pleased the Senate … has taken off the table the idea of expanding Medicaid. Now the conversation has shifted from that to how do we make sure more Floridians have access to insurance? That’s a very worthy conversation to have," said Weatherford, R-Wesley Chapel.

"They’re talking about private sector ideas, innovative ideas ...that’s something the House is interested in talking about,” he said.

In an op-ed published Wednesday in the Tampa Bay Times, Weatherford wrote:   “Although I personally oppose the expansion of Medicaid, I also recognize it's not enough to simply say no. The state has an obligation to investigate and pursue viable alternatives that will be in the best interest of all Floridians. And that's exactly what we're doing in the Florida House.”

The not-Medicaid plan for those who would be newly covered is still being drafted and apparently doesn’t yet have a name. In describing it Monday, Sen. Joe Negron just called it the “Florida Plan.” Other Senators called it the “Negron Plan."

The consultants' report on which Negron based his savings forecast called it the “Medicaid Benchmark Plan for Potential Adult Medicaid Expansion.” That report was done before the Legislature banished the word "Medicaid."

Feds: “We’re Flexible”

Negron, chair of the Senate Select Committee on the Affordable Care Act, talked about the not-Medicaid plan on Monday as an alternative to expanding Medicaid the way the ACA describes. He said it wouldn't be right to just leave the 1 million poorest of Florida's 4 million uninsured without access to health care -- the confounding result if states vote no on the Medicaid expansion under ACA.

The committee followed his suggestion and voted 7-4 -- along party lines, with Republicans in the majority -- to turn it down. Headlines around the nation took that as a definite no.

But there were numerous reasons why that vote was instead a "maybe," apart from Negron's stated angst about leaving hard-working poor people without access to health care.  One is that leaving an estimated $51 billion over 10 years on the table wouldn't play well with many Floridians. The law calls for 100 percent federal funding for the Medicaid expansion group for three years, and at least 90 percent thereafter.

Another reason the vote likely isn't a definite no is that it would leave Republican Gov. Rick Scott, who voiced support for the Medicaid expansion, looking ineffectual as he heads into the 2014 re-election campaign.

Still another is that budget experts both inside and outside state government have warned the Legislature that if Florida doesn't cover that 1 million people somehow, hospitals and employers will pay the price. The ACA took some money away from hospitals on the assumption that low-income working adults would be covered under Medicaid.

And employers will be charged a penalty if their workers sign up for subsidized coverage on the health exchange -- which is likely if Florida doesn't cover them. That is why two large employer groups, Associated Industries and the Chamber of Commerce, have recently expressed support for some form of Medicaid expansion.

In his remarks to the committee on Monday, Negron noted that several other states, including Indiana and Arkansas, have been talking to the Department of Health and Human Services about the prospect of using the Medicaid expansion funds for their own state-created plans.

He referred to a letter sent to state Medicaid directors on Nov. 20, which says that states have “significant flexibility to design Medicaid benefit packages."

An HHS official, who spoke with Health News Florida Wednesday on the condition he not be named, said the agency wants to be “flexible” in its dealings with states. He used the word several times.

In a follow-up e-mail, he wrote: “HHS is committed to supporting state flexibility and working with states to design Medicaid programs that work for them, within the confines of the law.  HHS stands ready to work with states to explore options that improve care and lower costs in the Medicaid program."

Speaking of costs…

The Milliman health-care consulting company in Brookfield, WI, produced a financial analysis for the Florida Agency for Health Care Administration that showed a “Medicaid Benchmark Plan” could be opened to the working poor at a lower cost than the state spends on its current Medicaid plans.

The Milliman study, which uses AHCA numbers, assumes that the new enrollees would use the health-care system at about the same rate as the current population and would have significant co-pays for big-ticket items.

The co-pays would be greater for the new group than for current Medicaid patients.  For example, a hospital stay would cost $2 for current Medicaid enrollees, $3.80 for Benchmark Plan members with incomes under the federal poverty level, and 10 percent for those with incomes between 100 and 138 percent of poverty.

The same cost arrangement holds for a visit to a physician, chiropractor, eye doctor or physical therapist. (See report There would be no charge for emergency services.

Out-of-pocket costs would be capped at 5 percent of family income in the Benchmark Plan.

The Milliman report assumes the cost of covering the new expansion enrollees would be about the same as those now enrolled in Medicaid. If so, the report says, the savings could be 3-to-4 percent, or between $109 million and $145 million, in 2014-15, the first year of the expansion program.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.