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If FL Medicaid Expansion Plan Passes, Still Faces Negotiations With Feds

Joan-Alker-cropped.jpg
Georgetown University Health Policy Institute

A plan to provide health care coverage to 800,000 Floridians faces an uphill battle after unanimous approval by the Senate Health Policy Committee.

Joan Alker, executive director of the Georgetown University Center for Children and Families, said Wednesday that the Senate plan includes requirements that federal health officials at the U.S. Centers for Medicare and Medicaid Services (CMS) may not support.

She said SB 7044 requires people to pay monthly premiums ranging from $3 to $25, depending on whether they're below or above the poverty line. That's very different from other Medicaid expansion alternatives other states have had approved by the Centers for Medicare and Medicaid Services.

“The bill does include premiums for everyone starting at zero percent of the poverty line. As we’ve learned from Indiana, Iowa and Michigan, CMS has not been willing to approve enforceable premiums below poverty and for good reason- they’re a clear barrier to coverage,” she said.

“But they (CMS) have been willing to approve very complicated cost-sharing arrangements which are different in each of those three states I mentioned and they do involve people paying monthly costs all the way down to the poverty line.”

The Senate plan proposes using a state-wide private insurance marketplace for these low-income Floridians, using the existing Florida Health Choices exchange.

The new Florida Health Insurance Affordability Exchange Program, or FHIX, would assist Floridians not eligible for Medicaid in purchasing health benefits coverage and gaining access to health services, according to the bill.

During a press conference in Tallahassee Wednesday, Senator David Simmons (R), Maitland, said making way for the new system is just the beginning.

“We already are taking Medicaid moneys, a lot, billions and billions of Medicaid dollars. I would like to reform that system as well, Simmons said.” “I think this is a wonderful opportunity for us to go ahead and treat this almost like a pilot project. To get this done, certainly take down the $52 billion that belongs to Floridians and at the same time provide a model-a model that we can use that is a free enterprise, free market based model for the rest of healthcare in the state of Florida.”

It's similar to the Arkanasas state health exchange, which has been approved by CMS, Alker said.

“Purchasing coverage through this type of exchange is a new twist on an Arkansas-style approach,” Alker said.

Also, a work mandate under the proposed plan would require participants to work 30 hours a week if they don’t have children, and 20 hours a week for parents of children under 18. Unemployed adults could qualify by spending that time searching for employment, participating in job-training or placement activities or pursuing their education.

Disabled adults and their caregivers could file for an exemption.

Veteran watchers of the Medicaid expansion debate know this work-requirement issue arose in Pennsylvania, where the governor included a similar request in his original proposal. By the end of negotiations, it was removed.

Utah’s governor was also negotiating on this issue with the federal government.

“Conditioning eligibility on work or job training requirements is not going to pass muster, but thinking through linkages to job training resources and program and perhaps, in a new twist, educational opportunities, may very well be an area CMS is willing to negotiate on,” Alker said.

Whether CMS even gets the chance to negotiate and sign off on the bill is uncertain. It first faces more committees and needs approval by the Florida House, which has shut down similar bills the past two years.

Daylina Miller is a reporter for WUSF in Tampa. Health News Florida receives support from the Corporation for Public Broadcasting. Information from WFSU was used in this report.