1. Health

Bill Nelson seeks local solution to expand Medicaid in Florida

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Published Apr. 16, 2014

TALLAHASSEE — Expanding Medicaid to cover thousands of uninsured Floridians has mostly been ignored by Republicans during this year's legislative session, but U.S. Sen. Bill Nelson is making a last-ditch effort to get it done.

Medicaid is a joint state-federal program, though most of the expansion called for under the Affordable Care Act would be funded by Washington. Still, Florida Republicans have balked, claiming that in the future, the burden on state funds would be too great.

Politics may be an even bigger problem than money, since Medicaid expansion is key to the success of President Obama's signature health law.

For months, Nelson, a Democrat, has sought a way around the opposition while still meeting federal requirements. He thinks he has found it in a never-tried-before plan: Using health care dollars raised by counties to pay the state's share of the expansion once it is required after the first three years.

"If you really want to get it done, and if your reason for opposing it really was that you didn't want to commit state tax dollars in the out years to expanding Medicaid, then this is the opportunity to do that," Nelson said Wednesday.

His plan would require the 32 counties that boost their hospitals' Medicaid funding with local dollars to instead use $3.5 billion of that money to cover the state's part of the expansion for 10 years. All 67 Florida counties would benefit, even if they didn't contribute.

"Whatever is done has to be done on a statewide basis," to meet federal requirements, said Tony Carvalho, president of the Safety Net Hospital Alliance of Florida.

Nelson said hospitals and county officials have indicated to him that they're willing to shoulder the burden so people who lack primary care aren't forced to seek help at emergency rooms.

"It's like taking the local tax dollars out of one pot and putting it in to another pot, and it's the same tax dollars," Nelson said. "That's why they're willing to do it."

Still, safety-net hospitals have to protect themselves, said Edwin L. O'Dell of Jackson Health System. While Miami-Dade's largest public hospital system ended the last fiscal year with a $45 million surplus, it was near bankruptcy not long ago.

"We are going through a transformation," O'Dell said. "We still have a lot of work to do."

But even if counties put up the money, the federal government would likely still require Tallahassee to approve and administer the program.

A spokeswoman for Senate President Don Gaetz said Nelson's plan isn't the answer.

"Utilizing local dollars to fund the state portion of an expansion of traditional Medicaid does not address President Gaetz's concern with the federal government's ability to finance Medicaid expansion in the long-term or his belief that traditional Medicaid is a broken program that providers, patients and taxpayers are unhappy with," spokeswoman Katie Betta said.

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Betta also pointed out that federal officials have expressed concern about the state's reliance on local dollars for Medicaid, and Nelson's proposal appears to make that worse.

The Legislature is off until Monday when it returns for the final two weeks of session.

Even if it fails, Nelson's attempt to re-ignite the debate is laudable, said South Florida Hospital and Healthcare Association president Linda Quick. "I was glad to hear and read he was pursuing out-of-the-box kinds of ways to diminish or mitigate (lawmakers') opposition," she said.

By not expanding Medicaid, Florida has created a group of about 764,000 adults who make too little to qualify for subsidies on the ACA insurance exchange but too much to qualify for the state's stingy program.

Florida leaders may not want Medicaid expansion, but that doesn't mean they don't want other help. The state had tried to get more money for its Low Income Pool program, a fund that would have been unnecessary if Medicaid were expanded.

Last week, the U.S. Department of Health and Human Services said no to that request. But it will continue to provide $1 billion for the fund, averting a potential state budget crisis.

A representative of the Centers for Medicare & Medicaid Services sent Nelson a letter last week saying HHS would be interested in working with Florida officials to flesh out his Medicaid expansion plan.

Still, Nelson says he is realistic about the proposal's prospects.

"If (legislative leaders') real reason for not expanding Medicaid is they're not going to do anything to support anything having to do with the Affordable Care Act because of their ideology or because they don't like the president, then of course answering their stated objection isn't going to make any difference," the senator said.

Times/Herald writers Marc Caputo, Jodie Tillman and Kathleen McGrory contributed to this report. Tia Mitchell can be reached or (850) 224-7263.