Monday, December 18, 2017
Editorials

Scott should reject bill that punishes counties on Medicaid

Gov. Rick Scott talks a lot about running a state that accounts for every tax dollar it spends. That same ethos should apply to how Florida treats its county governments and their taxpayers. Scott needs to reject the Legislature's unfair scheme to withhold counties' share of state revenue if they don't blindly pay disputed Medicaid bills. The governor should veto HB 5301 and tell lawmakers to try again.

The conundrum for Scott, of course, is that this bill contains more than one policy change. The legislation has a potpourri of health care issues tied to next year's state budget. (The budget, a separate bill, has not yet made it to the governor's desk.) For example, this bill wisely lifts the ban that had prevented low-paid state employees from enrolling their children in the state-subsidized KidCare health insurance program.

But even that good policy isn't enough to compensate for other budget gimmicks in the bill, including an arbitrary limit of six emergency room visits annually for Medicaid recipients, except children and pregnant women. For hospitals that unknowingly treat a Medicaid patient on his seventh visit in a year, the bill would deny any reimbursement for costs, ultimately shifting that burden to hospitals and the communities they serve.

But the most egregious scheme in the bill would undercut counties' ability to challenge whether they owe the state money for a specific Medicaid patient's bill. Under state law, counties are required to chip in when one of their residents who qualifies for Medicaid stays more than 10 days in a hospital or moves into a nursing home.

Over the past decade, more than $325 million in disputed bills have stacked up, apparently due in part to the state's error-ridden billing system. Now lawmakers want the counties to fork over roughly $300 million to settle those bills over the next several years or lose the same amount in state revenue-sharing receipts.

Never mind that several counties' audits have found the Agency for Health Care Administration frequently misidentified where patients live or issued duplicate bills for individual patients' treatment. In the Legislature's view, counties are just supposed to pay up or risk losing an identical amount of state revenue sharing. The only redress would be an appeal before the state's administrative courts.

That's no way to do the government's business. Scott should veto HB 5301 and order the AHCA to launch an honest, transparent effort to figure out which counties are liable for which bills. Anything less is unfair to the counties and their taxpayers.

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