In unexpected reversal, Florida opts into the Medicaid expansion

Decision came after HHS approved state Medicaid waiver requests

Florida Gov. Rick Scott (R) on Wednesday announced that his state will participate in the Medicaid expansion, making him the seventh Republican governor to support the Affordable Care Act (ACA) provision.

The announcement was widely unexpected because he was an early and outspoken opponent of the ACA. In November, Scott—a former hospital executive—began softening his stance on the law and said he might be open to discussions on the Medicaid expansion.

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Scott said his state would participate in the expansion for at least the first three years—2014 through 2016—during which time the federal government has agreed to pay 100% of the costs. The expansion program would have to be reauthorized in 2017, he noted.

Speaking at a news conference, Scott said, "[O]ur options are either having Floridians pay to fund this program in other states while denying health care to our citizens, or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms."

Scott's expansion plan—which officials estimate would extend Medicaid benefits to about one million more eligible residents—will be subject to approval by the state's Republican-led Legislature, according to Reuters. There currently are 6.1 million uninsured residents in Florida.

The Legislature's Republican leaders said they would consider recommendations by a select committee, which has been convened to review all options, before a final decision is made.

At the Wednesday news conference, Scott also confirmed that the state will not establish its own health insurance exchange under the ACA.

Scott's decision follows approval of managed care waivers

Scott's reversal on the ACA Medicaid expansion came shortly after HHS approved the second of two waiver requests, which would allow Florida to enroll nearly all of its Medicaid beneficiaries into the state's managed care program.

Scott previously told HHS Secretary Kathleen Sebelius the move was necessary for the state to participate in the expansion. According to the Associated Press, Florida officials had been negotiating with CMS to obtain the waiver approvals for nearly two years.

In a news release, Scott called the approval decision "a great win" for the state.

Meanwhile, HHS noted in its approval letter that the government will work with the state on a "consumer support program" to relieve beneficiaries' concerns (Campo-Flores et al., Wall Street Journal, 2/20; Alvarez, New York Times, 2/20; Cotterell, Reuters, 2/20; Kliff, "Wonkblog," Washington Post, 2/20; Kennedy, AP/Washington Times, 2/20; Kutscher, Modern Healthcare, 2/20 [subscription required]).

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