Florida Gov. Rick Scott’s high-stakes visit to Washington Wednesday to persuade the Obama administration to keep the federal government’s $1 billion in annual funding for hospital care of the poor produced no breakthrough.
“We had a good conversation … but we don’t have a resolution,” the Republican governor told reporters after an hour-long meeting with U.S. Health and Human Services Secretary Sylvia Burwell.
Burwell said in a statement that Florida’s request for federal funding “falls short of the key principles HHS will use in considering proposals regarding uncompensated care pool programs.”
Burwell added the decision on whether to extend funding for what’s known as the Low Income Pool beyond the program’s June 30 expiration does not depend on the state’s decision to expand Medicaid.
A letter HHS sent the state last month appeared to tie the two together and spurred Scott to file suit against the administration, alleging it was trying to coerce the state to expand Medicaid. The governors of Texas and Kansas, which receive similar funding to help their hospitals, have said they support Florida’s lawsuit.
But after meeting with Scott, Burwell insisted that “whether a state receives federal funding for an uncompensated care pool is not dependent on whether it expands Medicaid, and that the decision to expand Medicaid, or not, is a state decision.”
That seemed to leave open the question of whether some funding might still be available for the program, albeit at a lower level, if a state does not expand.
Scott said he needs an immediate answer from HHS on how much money, if any, the administration might provide so he and the state Legislature can complete their budget deliberations. “We need our answer right now,” he said.
Burwell indicated he might have to wait a while longer.
“HHS heard the Governor’s request for a timely response to help the state meet its budget timeline,” her statement said. “HHS believes completion of the public comment period, on-going discussions with the state, and the state’s submission of its proposal to CMS are the next steps in the process.”
The 30-day comment period has about two weeks remaining.
Florida is one of 21 states that chose not to expand Medicaid under the Affordable Care Act. That left about 800,000 Floridians without coverage. Burwell has said HHS prefers the state expand coverage rather than continue full federal funding of the low-income pool.
The bitter dispute over Medicaid expansion between Republicans who control the state House and those who control the Senate led the Florida Legislature to adjourn last week without passing a state budget for the fiscal year that begins July 1. Lawmakers are expected to return to Tallahassee in June to resume budget deliberations.
The state House has adamantly opposed expanding Medicaid, with House Speaker Steve Crisafulli last week calling it a “broken system with poor health outcomes, high inflation, inseverable federal strings, and no incentive for personal responsibility for those who are able to provide for themselves.”
But on Wednesday, Scott had good things to say about how well Medicaid was working in Florida. In the past two years, the state has turned over most of the Medicaid program’s operations to private Medicaid health plans. “We now have a program that works,” Scott said. “We know what it’s going to cost us. We have insurance companies responsible for taking care of Medicaid recipients and we have Medicaid recipients who know who is responsible for their care…and we now have a budget surplus.”
Nonetheless, Scott said he doesn’t trust the federal government’s promise to fund Medicaid expansion under the health law and the state will be on the hook to pick up too much of the cost. The federal government is paying all the costs through 2016 and then nothing less than 90 percent of the costs.
A year ago, federal officials warned Florida leaders the low-income program would end this year but Scott included the money in his proposed state budget anyway.
--Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
