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Feds Like FL Plan, But Some FL Officials Don't Want Feds' Money

In the Friday afternoon rush, those who are tracking the debate on Florida Medicaid expansion may have missed three important events:

--The federal government made its offer of 100-percent initial funding official by releasing the rules for the Medicaid expansion part of the Affordable Care Act.

--Economists from the University of Florida released a study indicating that accepting the money and expanding Medicaid to those under 138 percent of the poverty level -- an approach that State Sen. Joe Negron's "Healthy Florida" plan adopts -- would add 122,000 jobs in the state.

--State Sen. Aaron Bean offered an alternative plan that is more to the liking of House leaders -- it offers benefit accounts, not insurance, to those at 100 percent of the poverty level. And it would reject the extra federal funds.

The federal government released the official rules that say it will cover 100 percent of the cost of expansion for the joint federal-state insurance program for the poor for three years, tapering to 90 percent by 2020.

And it sent the clearest signal yet that the leading proposal for coverage of 1 million low-wage Floridians – “premium assistance” for private plans -- will get a quick blessing from the Department of Health and Human Services.

“We remain committed to working with states and providing them with the flexibility and resources they need to build new systems of health coverage,” wrote Cindy Mann, in charge of Medicaid programs at the Centers for Medicare and Medicaid Services. 

Mann’s note “is highly supportive of alternative solutions to the Medicaid expansion,” wrote health-care analyst Sheryl Skolnick of CRT Capital Research.  “(S)tates waiting for CMS to give the ‘okay’ now have a road map to get it,” she wrote, adding that this will make it easier for Florida, Tennessee and maybe even Texas to follow Arkansas’ example in covering the new Medicaid population with private-plan subsidies.

Mann’s description of the alternative Medicaid expansion proposal neatly matches the “Healthy Florida” plan that Sen. Joe Negron developed. It would use $51 billion in federal funds over 10 years to cover  1 million Floridians who would be eligible under the  new guidelines.

Mann’s note, which came with a Q-and-A,  accompanied the HHS release of  the rules under the Affordable Care Act that make the funding offer official: 100 percent federal funds for the first three years, then tapering to 90 percent in 2020, and remaining at that level.

State budget analysts who came up with the $51 billion estimate in federal funds said the state’s contribution will be about $3.5 billion. Critics of taking the money say they don't believe the federal funds will come through, while supporters say the economic ripple effects will create more than 100,000 new jobs.

Both the Florida House and Senate have voted down the idea of expanding traditional Medicaid, but the Senate Appropriations Committee quickly endorsed Negron’s “Healthy Florida” plan. Those eligible would be people whose incomes are up to 138 percent of the federal poverty level -- mainly adults who work full-time in minimum-wage jobs or who work part-time.

Over the weekend, Sen. Aaron Bean offered an alternative plan that would not offer insurance coverage, but instead “health benefit accounts” for those under 100 percent of the poverty level, News Service of Florida reports.  Under Bean’s plan, Florida would reject federal funds.

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.