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Counties still not happy with Medicaid billing compromise

One of the final decisions made during budget deliberations between House and Senate leaders was agreeing on a new system for billing counties for Medicaid costs. The formula, contained in SB 1520, will require counties to pay according to the percentage of Medicaid enrollees that live in their boundaries starting in 2015.

The formula also increases the amount collected  each year proportionate to the state's Medicaid costs increases. The changes would be phased in from 2015 through 2020.

Counties say the compromise struck by by Senate budget chief Joe Negron, R-Stuart, and House budget chief Seth McKeel, R-Lakeland, addressed some of the concerns. But many are still unhappy with the new formula, for various reasons.

Smaller counties prefer the status quo, where they are billed according to the actual services received by their residents. Some small and rural counties' Medicaid costs could rise dramatically under the new formula.

Larger counties have concerns, too. They don't like that they will pay more each as the state's Medicaid costs rise. After all, they argue, their share of Medicaid costs has remained unchanged for nearly a decade even as Medicaid continues to eat a larger portion of the state budget.

Counties also say the change removes the accountability that comes with receiving a bill each month that can be reviewed and challenged.

There is not much that can be done now, since the new formula is part of a budget conforming bill that can't be amended. But counties are still griping and weighing their options.

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