Florida lawmakers veto Medicaid expansion, eye Arkansas model

Scott had proposed a three-year expansion for the Sunshine State

Topics: Medicaid, Reimbursement, Finance, Payer and Regulatory Policy, Market Trends, Strategy, Health Policy

March 12, 2013

The Florida Senate select committee on the Affordable Care Act (ACA) on Monday voted 7-4 along party lines to reject Gov. Rick Scott's (R) proposal to participate in the ACA's Medicaid expansion. 

  • Is your state expanding Medicaid? Our Medicaid  map identifies governors who say they will opt into expansion. But, how many states are really option? As with the Florida, the devil's in the details—and the Legislatures.

Scott—a longtime opponent of the ACA—recently changed his stance on the Medicaid expansion after reaching an agreement with federal officials that allows the state to shift thousands of older Medicaid-eligible residents in long-term care programs into private Medicaid managed care plans.

Scott's proposal for a three-year Medicaid expansion trial completely funded by the federal government has faced opposition in the Republican-controlled Legislature, which has questioned the federal government's ability to sustain funding for the expansion. Last week, a Florida House panel also voted against Scott's proposal.

State Sen. Jeff Brandes (R) said the state should pursue a way to cover its residents that is stronger than Medicaid. He added, "Why in the world would we take the federal government's position when they promise that they'll pay for Medicaid expansion when we know that they will be unable to keep that promise in the long run?"

Panel proposes alternative coverage expansion

The Senate panel proposed a compromise that would allow the state to accept federal dollars under the ACA to provide private insurance coverage for uninsured residents, rather than shifting them into the Medicaid program. A Senate committee is expected to develop a plan that would allow the state to use federal funding to expand Florida Healthy Kids—a well-established health care exchange for low-income children—to one million uninsured adults who qualify for coverage under the ACA and allow them to choose from various private plans.

HHS last week approved a similar plan in Arkansas. That plan allows Arkansas to provide private health coverage to more than 200,000 uninsured residents with incomes up to 138% of the federal poverty level through the insurance exchange that the state will operate in partnership with the federal government.

  • Need a refresher on the state health exchanges? We've got you covered with a quick review of the ACA marketplaces, including when they're rolling out, how they work, and what it means for you.

Critics of such a plan say it could end up being much more costly to the federal government than regular Medicaid expansion. Adding an individual to Medicaid costs about $6,000, while purchasing private coverage would cost about $9,000, according to Congressional Budget Office estimates.

According to the Washington Post's "Wonkblog," the Obama administration could face finding issues if it allows states with millions of uninsured individuals, such as Florida and Texas, to provide private coverage under the Medicaid expansion (Mitchell, Miami Herald, 3/11; Radnofsky/Campoy, Wall Street Journal, 3/11; Alvarez, New York Times, 3/11; Kliff, "Wonkblog," Washington Post, 3/11).

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