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Did the Trump administration make it harder for Florida to expand Medicaid on its way out the door?

Hospital advocates say the answer is no. Some advocates worry the answer is yes.
Donald Trump's proposed budget includes deep cuts to Medicaid and food stamp programs. [Times files]
Donald Trump's proposed budget includes deep cuts to Medicaid and food stamp programs. [Times files]
Published Jan. 22

TALLAHASSEE — At first, Florida only wanted the federal government to re-up the state’s Medicaid program into 2024.

But last week, in the final days of Donald Trump’s presidential administration, the feds extended the state’s program through June 2030.

That struck some Florida advocates for Medicaid expansion under the Affordable Care Act as suspicious timing. Under Florida’s current system, the state hospitals that provide so-called “charity care” to the poorest patients get reimbursed by a combination of federal and local funding commonly referred to as the “Low-Income Pool.”

With another decade of generous federal funding for the Low-Income Pool, those advocates say, lawmakers might be less inclined to then expand Medicaid — long an objective of state Democrats.

“I do see it as relief for the current administration not to feel the pressure of expanding health care,” said Sen. Janet Cruz, D-Tampa.

The Safety Net Hospital Alliance of Florida, the organization that represents many of the hospitals that both fund and receive money from the Low Income Pool, does not see it that way. The group’s CEO, Justin Senior, said there was no reason the state couldn’t expand Medicaid and also allow hospitals to be reimbursed for charity care.

Senior noted that several states, including California have expanded Medicaid while allowing the federal government to reimburse providers for charity care.

“If you want to talk about expansion, talk about expansion,” Senior said.

In Florida, Medicaid, which is funded by both the federal and state governments, covers poor children, poor pregnant women, some seniors, people with disabilities and poor parents. On Friday, Democrats in the state House and Senate announced they were filing bills to expand the Medicaid, in effect offering coverage to hundreds of thousands of additional poor working Floridians.

Those proposals will almost certainly die in the Republican-controlled Legislature.

Currently, only parents and caretakers who make less than 31 percent of the federal poverty level are eligible for the program, according to the Florida Policy Institute, which has advocated for expanding the program. That’s about $7,000 per year for a family of three.

If Medicaid were expanded, families making up to 133 percent of the federal poverty level — about $28,887 per year for a family of three — would be covered under the program.

The federal government would pick up 90 percent of the tab.

Republicans have argued Medicaid expansion would make the program bloated and costly, adding more bureaucracy just to provide mediocre health care coverage to Florida’s working poor.

Joan Alker, a professor and the Executive Director of the Center for Children and Families at Georgetown University, argued that even the worst coverage is better than no coverage at all.

“Those who oppose Medicaid and say it’s not good enough insurance, I would say to them, ‘Are you willing to give up your insurance and be uninsured?’” Alker said. “If you were uninsured, you’d be happy to have Medicaid.”

Expansion or no, because Florida’s Medicaid operation has unique features that are not spelled out in federal law, the state has to apply periodically for a waiver from the federal government to run its program. The federal government’s move to approve that waiver had been in the works for months before the November election between Trump and Joe Biden.

Alker said she saw the extension of Florida’s Medicaid program by the federal government as a way for Gov. Ron DeSantis’ government to bolster Florida’s conservative approach to health care while a Republican was president.

“Clearly, Gov. Desantis made a decision that, in case President Trump lost the election, he would be wise to get (his proposal) in there before Jan. 20, 2021,” Alker said.

The federal government gave Florida up to $1.5 billion in Low Income Pool funding to reimburse health care providers for their charity care in 2020. Providers used about $1.1 billion of that, state records show.

Alker argued that Florida’s health care system relies too much on this kind of funding. Paying hospitals, for example, to provide free emergency treatment to the poor and uninsured is less effective than simply expanding federal insurance to some of those people, she said.

It’s also unclear why Florida’s Medicaid program was extended a full six years longer than initially requested. The state’s Agency for Health Care Administration did not respond to a request for comment.

Senior said extending Florida’s Medicaid program for several years was the right thing to do because it will give providers the ability to plan into the future.

There is no reason to use Low Income Pool funding as a political weapon in the fight over Medicaid expansion, Senior said.

“We’re happy with the stability,” Senior said.