State’s Medicaid Block-Grant Request Draws Opposition

Governor Rick Scott isn't waiting for the federal government to decide the future of the Affordable Care Act. His administration is proposing sweeping changes to the state's Medicaid program.  

The state laid out its idea in a letter to Health and Human Service Secretary Tom Price last month.

The Agency for Health Care Administration is asking for more flexibility in administering Medicaid -- a program that serves nearly 4 million poor and disabled residents, including more than 2 million children.

Health News Florida invited secretary Justin Senior to discuss the proposal,  but he and others from the agency declined our request.

So here are some key points to know about the plan, which would affect how the state distributes the roughly $16 billion it gets from the federal government for Medicaid each year.

First, the state wants to receive one lump sum payment from the federal government for Medicaid instead of several payments earmarked for specific things. The lump sum, known as a block grant, would give the state more flexibility, supporters say.

But Democrats aren't so sure. Miami State Rep. Nicholas Duran says block grants may seem to free states' hands but they actually limit what states can do.

“A block grant program, to me I don't see flexibility,” Duran said. “What I see is we are now limited to those dollars and when a public health crisis occurs similar to, say, Zika or as we're seeing unfolding right now with the opioid epidemic these sort of public health issues have added costs to our health care system," Duran said.

"And if we are limiting ourselves or capping ourselves and revising the partnership between the federal and state and how we fund Medicaid, I think we're positioning ourselves to not be able to absorb these sorts of scenarios.”

Senior's letter addresses the concern about capping payments: Since the state provides care efficiently, and as a result spends less per person on Medicaid than other states, that should be taken into consideration and rewarded when issuing the block grants, he says.

Block grant funding is just one of the requests in the proposal. Senior wrote that Florida shouldn't be forced to provide "retroactive" coverage for some who enroll in Medicaid after they have already run up big health-care bills.  He says doing away with the practice will not compromise the quality of care in any way. And it would save Florida up to $500 million dollars a year.

Duran, who serves on the House's Health Care Appropriations Subcommittee, says this rule would strip protection from those who need it most.

“The number of children that we fund is, it's pretty large. I think it's somewhere near 60 percent goes towards funding our children,” Duran said. “But we also use this funding for our most vulnerable population, our low income elderly. So what we're dealing with and what we're talking about are some of our most vulnerable populations in this state. When I think about that, that question and that recommendation to me is potentially hurting those most vulnerable in our state. And that doesn't sit well with me.”

Like Gov. Scott, the letter from the Agency for Health Care Administration criticizes "Obamacare," saying that it uses big government and regulation to expand health coverage.

But Duran notes that some of the proposals in Senior's letter -- like one promoting the use of primary care instead of hospitals -- sounds a lot like provisions of the Affordable Care Act.

“The expansion of Medicaid in many respects is to do that, right?” Duran said. “It's to move folks from getting their health care out of the back of an ambulance or an emergency room, and doing so with doctors and with establishing a medical home. So sure, are those the kinds of benefits that we want to have? Yeah.”

Senior ends his letter by expressing confidence that the changes will allow Florida to focus on providing access and quality care to its most vulnerable populations. His spokeswoman said the agency is still discussing the issues with the federal government. 

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