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Sen. Negron Unveils Alternative Plan

Tampa Tribune

"Healthy Florida," state Sen. Joe Negron's plan to cover 1 million low-income working adults, is now in writing and has been placed on the agenda for Thursday's meeting of the Senate Appropriations Committee.

SPB 7038 is likely to get a respectful hearing there, since Negron chairs that committee. The bill isposted for reading online, with the pertinent section beginning at line 1077.

The plan would take the place of the Medicaid expansion called for under the Affordable Care Act, which would extend coverage to the uninsured in households with an income at or below 138 percent of the federal poverty level. In Florida, that applies to around 1 million of the state's lowest-income working adults who have no health insurance.

To become law, it requires the approval of the House and Senate and the approval of Gov. Rick Scott, who has already indicated his support. But to be implemented, it would need federal funds, and that requires approval from the U.S. Department of Health and Human Services.

Two weeks ago, the House Committee on the Affordable Care Act voted along party lines to turn down the federal funds for Medicaid expansion. Last week, the Senate counterpart followed suit, but that was after  Negron said he would come up with "a better system than the one Washington created."

As Health News Florida reported, HHS signaled that it was willing to listen to what Florida wants. It sent a note that said "HHS stands ready to work with states to explore options that improve care and lower costs in the Medicaid program."

As laid out in the bill, "Healthy Florida" would be operated by the Florida Healthy Kids Corp., a non-profit that now provides coverage on a sliding scale to about 300,000 children across the state. It has experience in finding potential enrollees, getting them signed up, accepting payment for premiums, operating a call center for questions and complaints, and so on.

Healthy Kids' CEO Rich Robleto says his organization should be able to ramp up to take on the newly covered population if the plan becomes a reality.

But it has an ambitious timeline. Florida's Agency for Health Care Administration, which handles Medicaid funds, would submit the plan to HHS by June 14. That would require HHS to make a quick turnaround in order for Florida to begin enrollment on Oct. 1, with coverage to take effect Jan. 1, 2014. 

If HHS has objections to some parts of the plan, Healthy Kids Corp. would be able to make changes to gain federal approval "upon giving notice to the Senate and the House of Representatives." It is not clear what would happen if the changes were substantial or controversial, but presumably the governor could call a special session of the legislature to hash it out in time to get the funds flowing by Jan. 1.

Republican legislative leaders had rejected the notion of expanding Medicaid as it stands, saying the program is defective and "broken." But some, particularly on the Senate side, said they wanted to find a way to get access to primary and preventive health care for those hard-working Floridians who don't get coverage on the job because it isn't provided or they can't afford it.

And time is of the essence, since the federal government is offering to pay the full cost of covering this group for the first three years, tapering after that to 90 percent. State economists have estimated the state could receive about $51 billion in federal funds over 10 years, while having to put up only about $3.5 billion in state funds to cover those 1 million people.

Negron's plan, as described in the bill, would:

--Allow enrollees a 90-day tryout in a plan before a lock-in period begins.

--Require that 85 percent of the premiums be spent on health-care services for enrollees,  holding administrative costs and profits to no more than 15 percent.

--Provide a health reimbursement or health savings account for each enrollee, in which rewards can be placed for healthy behaviors and adhering to wellness or disease management programs.  Enrollees could use the funds from the account for co-pays or drug-store purchases.

--End if the federal match contribution falls below 90 percent.

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.