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  1. Florida Politics

Florida GOP lawmakers could go for Medicaid expansion — by any other name

Published Dec. 4, 2014

TALLAHASSEE — A coalition of state business interests and private citizens, including some prominent Republicans, unveiled a plan on Wednesday to accept federal dollars to extend health care coverage to nearly a million Floridians — without calling it "Medicaid expansion.''

The plan, called A Healthy Florida Works, offers an alternative to the model created by the federal Affordable Care Act. And it proposes a politically viable path for Florida's Republican-controlled House of Representatives, an obstinate opponent of the health law, to extend coverage to more residents.

Proponents have presented the plan as a "free market" solution that promotes "personal accountability" by requiring beneficiaries to pay monthly premiums and if unemployed to search for work or enroll in job training programs.

"Trying Medicaid expansion as envisioned in the Affordable Care Act hasn't worked in Tallahassee," said Linda Quick, a coalition member and president of the South Florida Hospital and Healthcare Association. "So this proposal is a Florida solution."

State Rep. Richard Corcoran, who in 2013 proposed an alternative to Medicaid expansion that did not use federal dollars, said he would be willing to consider the coalition's plan.

"It sounds like they are headed in the right direction," said Corcoran, a Land O'Lakes Republican who was recently tapped to lead the House Budget Committee.

But House Speaker Steve Crisafulli, R-Merritt Island, said it was "difficult to comment on the proposal because there are many unanswered questions."

"If this is just another attempt to expand the failed Obamacare plan, I would predict it would garner very few votes in the Florida House of Representatives,'' he said.

The proposal has the support of powerful Senate Rules Chairman David Simmons, R-Altamonte Springs — a close ally of Senate President Andy Gardiner, R-Orlando. The upper chamber has supported expanding Medicaid, as has Republican Gov. Rick Scott.

Under the ACA, states were supposed to expand Medicaid eligibility to nearly all adults with incomes at or below 138 percent of the Federal Poverty Level (about $16,000 per year for an individual, and $32,900 for a family of four in 2014).

But a Supreme Court ruling in summer 2012 made Medicaid expansion a state option.

So far, 27 states and the District of Columbia have expanded Medicaid eligibility. This week, Wyoming Gov. Matt Mead, a Republican, announced that he would back a plan for Medicaid expansion in his state.

There is no deadline for states to participate in Medicaid expansion. But the federal government's offer to cover 100 percent of the cost for those newly eligible begins to phase down after 2016 to 90 percent by 2020. If Florida were to expand Medicaid eligibility, the state would receive an estimated $5 billion a year in additional federal funding.

The Florida plan unveiled Wednesday would cover an estimated 800,000 to 1 million residents who do not earn enough to qualify for federal financial aid to buy a private plan on the ACA exchange, but who earn too much to qualify for Medicaid — placing them in the "coverage gap.''

Florida's current income limit for parents is approximately 35 percent of the poverty level, which means a single parent with one child can earn only $453 per month or less ($5,436 annually) to be eligible for Medicaid. A single disabled adult can make only $721 a month or less ($8,652 annually). Non-disabled adults without minor children are ineligible for Medicaid in Florida, no matter how poor they might be.

Among the states that have expanded Medicaid eligibility, most have done so as envisioned under the ACA. Only four states — Arkansas, Iowa, Michigan and Pennsylvania — have received a federal waiver to try a different model.

In approving waivers for those states, though, the federal Centers for Medicare and Medicaid Services, or CMS, rejected provisions that would have required beneficiaries to work as a condition of eligibility and that would have charged monthly premiums for individuals with incomes below the poverty level.

The plan for Florida calls for mandatory premium payments by all individuals, including those below the poverty level. However, the premiums would be used for individual savings accounts to be spent by beneficiaries for health care or education costs.

The "free market'' elements of the proposal include a provision for the state to establish and operate a private exchange, where insurance companies can offer health plans and receive a fixed monthly premium per beneficiary. Nearly all of Florida's estimated 3.5 million Medicaid beneficiaries were switched this year to managed care plans operated by private insurance companies and funded by state and federal dollars.

According to the published proposal introduced Wednesday, Florida's cost for implementing the program would be an estimated $1.4 billion from 2015 through 2020. But savings, such as in uncompensated hospital care, over the same time period in would be nearly $3.2 billion. Net state savings: $1.76 billion.

Contact Kathleen McGrory at kmcgrory@miamiherald.com.