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Tweaked Medicaid billing system for counties headed to Senate floor

The Senate budget committee agreed to phase in a new Medicaid billing system for counties over seven years instead of five. But that didn't stop county commissioners from across the state from speaking out against the legislation.

Senate Bill 1884 is headed for a floor vote but could see additional tweaks before then. Senators said the proposal may not be perfect right now, but it's their best attempt to create a new system to collect counties' share of Medicaid costs. Sen. Arthenia Joyner, D-Tampa, voiced concerns but still voted in favor of the bill.

"We need to tighten this up because a thousand dollars here, a million dollars there, makes a big difference in the lives of those who have to come up with it," she said. "We have much work to do before the floor."

Under the existing billing system, the one created just last year that sparked an uproar itself, counties pay according to actual services utilized by verified patients that live within their boundaries. Because the state is changing the way it pays hospitals for Medicaid, it also needs to change its billing system for counties.

Senate health care budget chief Denise Grimsley, R-Sebring, vowed to continue working with counties on additional fixes.

The proposal requires counties to pay a share of the Medicaid costs proportionate to the percentage of Medicaid enrollees that reside there. But that is softened by the seven-year phase in, so that counties aren't paying solely a proportionate cost until 2020.

Indian River Commissioner Peter O'Bryan said his county's Medicaid costs would jump from the current five-year average of $666,000 a year to $2 million over the phase-in period.

"That is just a huge hit in our budget, particularly in these tight times when we’ve been trying to deal with a declining tax roll," he said.

Counties say the gradual phase-in is an improvement, but they still want other changes. For example, they think the state is setting the baseline for the first year of implementation about $20 million too high which inflates all costs going forward. And they are also asking for caps to be built into the formula so that their annual costs won't fluctuate too wildly from year to year.

There is no companion legislation in the House for SB 1884, but the House could be asked to take up the Senate bill.