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Fingerpointing Over LIP, Medicaid Expansion

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Agency for Health Care Administration
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Saying that "sand is running out of the hourglass," the Republican leaders of the Florida Legislature said Wednesday that it appears they will end their annual session on May 1 without reaching a deal on health care and a new state budget.

The House and Senate are $4 billion apart in rival budgets and the leaders of the two chambers remain at an impasse over how to bridge the gap, which stems from a deep divide over whether to accept billions in federal aid to expand Medicaid. Medicaid expansion is linked to the federal health care overhaul pushed by President Barack Obama and is opposed by House Republicans.

"We're not willing to move away from our stated position," said a defiant House Speaker Steve Crisafulli, a Merritt Island Republican.

Top Republicans acknowledged that they will probably have to hold a special session to pass a budget. Part of the problem is that while the session ends on May 1, the state constitution requires that the budget be finished and on legislators desk 72 hours in advance.

The acknowledgement that time is short for the regular session came during yet another day of finger-pointing between the House, Senate, the administration of Gov. Rick Scott and the federal government.

Florida is in danger of losing more than $1 billion in federal hospital funding — a loss that state senators say would result in devastating cuts to hospitals, including hospitals that serve children. Federal officials say they want Florida to consider expanding its Medicaid program to 800,000 Floridians as part of any deal to keep the hospital money intact.

On Wednesday, U.S. Sen. Marco Rubio and five GOP federal lawmakers sent federal health officials a letter asking them to release the funding that helps hospitals care for low-income patients.

The letter states that federal officials "should not destabilize, eliminate or hold these programs hostage to an expansion decision" and should treat Florida no differently from California, a state that expanded Medicaid and was also granted federal hospital funds.

State health officials also chimed in. In a letter Wednesday to the Centers for Medicare and Medicaid Services, they warned that a 2012 U.S. Supreme Court decision said states could not be coerced into expanding Medicaid.

"Yet that appears to be exactly what the federal government is attempting here," Florida Medicaid Deputy Secretary Justin Senior said.

Senior complained this was the first time they had heard that federal officials were insisting Medicaid expansion should be part of any deal. However, records obtained by The Associated Press show the state Agency for Health Care Administration and the governor's office actually drafted the letter in late March.

In the intervening two weeks, state health officials released a series of public statements accusing federal health officials of walking away from negotiations and refusing to talk with Florida officials.

Lawmakers grilled AHCA Secretary Elizabeth Dudek about the contradictions Wednesday afternoon during her confirmation hearing. They voted to confirm her, but after the meeting, two Republican senators said they did not accept her statement that this week was the first time Scott administration officials were told that expansion was linked to more than $1 billion in federal aid for hospitals.

"That's not news to anybody despite what they may be telling you," said Sen. Tom Lee, a Brandon Republican and the Senate budget chief.

Federal health officials insist they are willing to work with the state and say Florida is free to implement expansion or not. But they pointed out Wednesday that the hospital funds are part of a broader grant and questioned whether it promotes the objectives of the Medicaid statute to rely on the feds when the state has options that would better serve the low-income population.

Florida health officials contend the state still needs the hospital funding even if they expanded Medicaid because there would still be uninsured and low-income patients seeking treatment at hospitals. They point to a study by the Urban Institute that says $1.6 billion in uncompensated care would still exist after expansion.

Hospitals say they need both the federal funds and Medicaid expansion because Medicaid covers less than half the cost of providing the care.