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The federal government may not have followed the law when it approved Florida's Medicaid reform. As a result, poor children and pregnant women are paying more for lower-quality health coverage, according to a legal opinion released Tuesday.

Health advocates said the opinion from the Government Accountability Office is more evidence that the Florida Legislature shouldn't expand the pilot program, which Gov. Jeb Bush spearheaded in 2005 to end Medicaid entitlement and reduce skyrocketing costs.

About 166,000 children, parents and people with disabilities participate in the pilot in Duval and Broward counties.

Andrew Leone of Florida Community Health Action Information Network said the report reinforces his organization's belief that the reform plan was half-baked.

"Medicaid reform in Florida was rushed through the Legislature for political reasons, without enough time to review its consequences on the consumers it is supposed to benefit," Leone wrote in an e-mail.

In a 13-page letter about Florida and Vermont's Medicaid programs, the lawyer for the GAO, the investigative arm of Congress, wrote that the Department of Health and Human Services overstepped its legal authority when it allowed Florida to implement the pilot.

Specifically, the report says the program violates standards by providing just a few health benefits while Medicaid recipients are deciding on their health plan and by subsidizing employer-provided health insurance without requiring it to offer top-notch benefits.

The federal government pays 56 cents of every dollar a state spends on Medicaid, so it imposes requirements on the quality of health care provided with the money. The government can waive those rules so that states can experiment with better programs, but the GAO opinion suggests Florida went too far by failing to provide minimum standards.

Joan Alker, a senior researcher for the Health Policy Institute at Georgetown University, said the waiver that allowed the pilot program to go forward was okayed in just eight business days. The quick approval set a "new world record," Alker said, because the president and then-governor of Florida are brothers.

"Florida's Legislature should think long and hard about that before expanding the pilots beyond the existing two counties," Alker said.

Stephanie Garry can be reached at (727) 892-2374 or